New Client Intake Form

Thank you for the opportunity to servicing you!

In 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 *	— Select from list —ArizonaCaliforniaNevadaOther
Company Market Segment *	— Select from list —AccountingConstructionDistributionEducationFinancialGovernmentHealthcareHospitalityInsuranceLegalManufacturingNot For ProfitReal EstateResidentialRetailTransportation
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	— Select from list —AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua And BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia, Plurinational State OfBonaire, Sint Eustatius And SabaBosnia And HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic Of TheCook IslandsCosta RicaCôte D’IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran, Islamic Republic OfIraqIrelandIsle Of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People’S Republic OfKorea, Republic OfKosovoKuwaitKyrgyzstanLao People’S Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia, The Former Yugoslav Republic OfMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States OfMoldova, Republic OfMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanOtherPakistanPalauPalestinian Territory, OccupiedPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension And Tristan Da CunhaSaint Kitts And NevisSaint LuciaSaint Martin (French Part)Saint Pierre And MiquelonSaint Vincent And The GrenadinesSamoaSan MarinoSao Tome And PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch Part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia And The South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard And Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province Of ChinaTajikistanTanzania, United Republic OfThailandTimor-LesteTogoTokelauTongaTrinidad And TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuela, Bolivarian Republic OfViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis And FutunaWestern SaharaYemenZambiaZimbabwe
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? *	— Select from list —BillingPrimaryPurchasingTechnical
Billing Portal Password *