New Client Intake Form

Thank you for accepting the proposal and entrusting us with your facility(s).

Please fill out this form, as it will provide us with vital information to proceed.

After you fill out this form, you will receive an e-Agreement in your email. Once that is received, please e-sign it to proceed.

Don’t hesitate to contact your salesperson if you have any questions when reading the e-Agreement.

We are excited to have you as an XPS Client!

Your Email(Required)

Important: Please use the email address you have been corresponding with our sales associate.

Business Name:(Required)

This is the name of the business you want listed on invoices.

Doing Business As (DBA):

If you have a DBA that is different than the Business Name, please list it here.

Billing Contact(Required)

First Last

This is the name of the contact you want listed on invoices or if we need to reach you for billing matters.

Billing Contact Email:(Required)

Billing Contact Phone:(Required)

Billing Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

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Comments

This field is for validation purposes and should be left unchanged.