New Contract / Billing Update Form
After you fill out the below form, we will contact you to go over details. If you would like an update on the process please contact (678) 528-7852 or accounting@localmarketinginc.com
Employee Name:
*
First Name
Last Name
Client Name:
*
Client URL:
*
Is this for a new or existing client?
*
New Client
Existing Client
Billing Update Type:
New Client
Upsell
Downsell
Updated Billing Information
Cancellation
Pause
Refund/Credit
Makegood
Updated Payment Information
Updated Billing Contact
Client Update Form
Contract Start Date:
-
Month
-
Day
Year
Date
When is the billing start date?
Contract Start Date (full monthly fee)
Contract Start Date (Prorated)
Other
Monthly Contract Amount:
Is LMi paying the client’s third party fees?
Yes
No
Please enter the amount:
Billing Type:
Credit Card
ACH
Invoice
NvoicePay
Billing Contact Name:
*
First Name
Last Name
Billing Contacts Email Address (for new clients):
*
example@example.com
Client Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
If this is an upsell, please write the updated monthly fee:
Comments:
Please attach contract or written approval:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Credits, Refunds and Cancellations
If this is for a new client or upsell, please skip this step
Billing update type:
Refund/Credit
Make Good
Cancellation
If Refund/Credit, please leave a short description:
Billing Change Start Date:
-
Month
-
Day
Year
Date
Billing Update:
Reason for billing change:
Please attach notice or approval for billing change:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Should be Empty: