ACCT Membership AV Referral Eligibility Check

ACCT Membership AV Referral Eligibility Check

Please fill this out so we can be absolutely sure that you are eligible for this referral program. If everything checks out we'll send you next steps to membership.
Your Name

First NameLast Name
Email
example@example.com
Name of Vendor or Vendor Employee who referred you
Operation Name
Operation Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Generic/General Operation Email (visible only to ACCT members in a member directory, unless you opt out)
example@example.com
Operation Phone
Please enter a valid phone number.Format: (000) 000-0000.
Operation Website
Primary Contact for Operation, if not you

First NameLast Name
Email for Primary Contact
example@example.com
This is the person who will have all the permissions when it comes to your company record. They'll be able to add/remove listed employees, edit the company profile (visible to other members unless you opt out), assign available membership seats, see past and present invoices, pay them, and assign other listed people to Management Access to also be able to do some of the above.
Additional Company Info
Non-Profit Status (no effect on eligibility, just helps us set up an account for you at the proper rates)
Does your company have any internal restrictions on Auto-Pay authorizations for services like our membership?
Past Company Names / Parent Company Names if applicable (this program is for companies who have not held an organizational level membership in the past three years)
Should be Empty:

ACCT Membership AV Referral Eligibility Check

Additional Company Info