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

Your preferred "go-live" date is when your department would like to start entering data into Informant. This helps inform the timeline for implementation. Your actual "go-live" date depends on several factors, such as if data needs to be migrated from another system into Informant.
Preferred go-live date (approximate)

MonthDayYear
Between now and when you go live, how will you be keeping records?
How long do you have access to your current RMS system?
When will you lose access to your current RMS system?

MonthDayYear

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.
Check the appropriate box to describe the Support/Main contact.

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.
Check the appropriate box(es) to describe the Billing contact.

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