New Client Intake Form – Legal Technology Solutions

New Client Intake Form

Thank you for the opportunity to servicing you!

thank youIn order for us to get an account created/ updated for you, we need to collect some information from you.

If you prefer to provide this information over the phone, we can gladly do so, however, to save time and to enhance the accuracy of the information, it’s always better to use this form instead.

Please note that we will not ask you for your credit card information on the below form, but we do require all of our customers to have a valid credit card on file. You will be contacted via phone by our billing department, and will be asked to provide the credit card information as the last step before your account can be activated.

If at any point you have any questions, please Email us at billing@legaltechnology.solutions , or contact our team via phone. We’re always happy to help !

Company Name *
Company Address 1 *
Company Address 2
Company City *
Company State *
Company Zip *
Company Phone *
Company Alternate Phone
Company Fax
Company Web Site
Company Territory Name *
Company Market Segment *
How to contact you after hours (email, call, etc) *
Company Number of Employees *
Primary Contact First Name *
Contact Last Name *
Contact Title *
Contact Business Address (Leave blank if it's the same as the Company Address)
Address 2
Contact City
Contact State
Contact Zip
Contact Country
Contact Work Phone *
Contact Phone Extension
Contact Mobile Phone
Contact E-Mail Address * (This will be used for your billing portal)
Contact Alternate Email
What is your general role? *
Billing Portal Password *