New Customer Information Form

New Customer Information Form

Please fill out the form below for our records. By submitting this form, you agree to receive emails from us as an Informant customer. You can unsubscribe at any time.
AGENCY/ORGANIZATION INFORMATION

Please complete the information below.
Agency/Organization Name*
Department Name will appear on account profile, contracts, invoices, etc.
Agency/Organization Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Agency/Organization Address*

Address Line 1

Address Line 2

CityState / Province

Postal / Zip Code
County*
Go-live with Informant

The "Go-Live" date is when your agency has completed Administration setup and is ready to start entering data into Informant.
Preferred go-live date (approximate)*

MonthDayYear
Date

CONTACT INFORMATION

Please provide the following details for each of the three contact types below.
(1) ACCOUNT CONTACT

The Account contact is the individual responsible for making decisions on behalf of the agency. This person has the authority to sign contracts and serves as the primary point of contact for important communications.
Account Contact Name*

Title (optional)First NameLast Name
Email (Account contact)*
Phone Number (Account contact)*
Please enter a valid phone number.Format: (000) 000-0000.

(2) SUPPORT/MAIN CONTACT

The Support/Main contact is the person who generally works directly with our support team to troubleshoot and resolve any issues that may arise. This person acts as the primary liaison for technical and operational concerns.
Same as Account contactSupport/Main contact is a separate role

Support/Main Contact Name

Title (optional)First NameLast Name
Email (Support/Main contact)
Phone Number (Support/Main contact)
Please enter a valid phone number.Format: (000) 000-0000.

(3) BILLING CONTACT

Please provide information for your agency's Billing contact. The billing contact is the person responsible for managing invoices, payments, and addressing any billing-related issues or questions.
Same as Account contactSame as Support/Main contactBilling contact is a separate role

Billing Contact Name

Title (optional)First NameLast Name
Email (Billing contact)
Phone Number (Billing contact)
Please enter a valid phone number.Format: (000) 000-0000.

AGENCY/ORGANIZATION INFORMATION