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Customer Intakeadmin2024-06-09T14:00:03+00:00

Client Intake Form

First and Last Name *

Email Address *

Business Name *

Physical Address *

Business Hours *

7am - 3pm

8am - 5pm

24/7

Other

Please List Your Hours of Operation *

Mailing Address *

Are you the Primary IT Contact of your business? *

Yes

You Selected "No" for "Primary IT Contact." Please list someone at your organization who wishes to be the IT Contact. (This person does not have to be technical)

Contact Name *

Contact Email Address *

Accounts Payable Information

Name of person in charge of Accounts Payable *

Accounts Payable Phone Number *

Accounts Payable Email *

ACH Payment Process: We utilize ACH (Automated Clearing House) for monthly payments. To get started, you will need to fill out the ACH form below. A few days before the auto draft occurs, customers will receive an alert letting them know that an ACH transaction is scheduled to occur. On the day of the draft, customers will receive an emailed receipt. All ACH transactions are scheduled for the first of each month.

Bank Transfer Authorization Form

By filling out and submitting the form below, you authorize Thin Blue Technologies to electronically debit your bank account according to the terms outlined below. You acknowledge that electronic debits against your account must comply with United States law.

Terms of billing:

Start Date (this is usually the first day of the following month) *

For the Amount of (please input total monthly quoted price) *

Bank account information:

Routing Number *

Accounting Number *

Account Type *

Checking

Savings

Business Checking

Business Savings

I understand that this payment authorization is to remain in effect until we notifiy Thin Blue Technologies of its cancellation by giving written notice in enough time for the business and receiving financial institution to have a reasonable opportunity to act on it.

First and Last Name *

What is your title? *

Please select today's date *

Help Us Help You Better

What would you say is your biggest issue currently with IT?

Wi-Fi Issues

Computers are slow

Printer Problems

Phone Problems

Network slowness

Server Problems

Something Else.

Please Describe *

What would you say was the best thing about your last IT support person/company?

What would you say was the worst thing about your last IT support person/company?

(573) 891-1929

Services We Offer

Security Cameras

Managed Phones

Managed IT

Website Design Services

Need help with something else?

Client Intake Form

Accounts Payable Information

Bank Transfer Authorization Form

Help Us Help You Better