Onboarding AFI

NEW CUSTOMER ONBOARDING – AUGUSTA FINANCIAL

Please complete the form below as needed. For more than 5 service locations, contact your AmeriTel representative.

Company Name(Required)

Main Billing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Main Account Contact Name(Required)

Main Account Phone(Required)

Main Account Contact Email(Required)

Other Authorized Personnel

AP Contact Name(Required)

AP Contact Phone(Required)

AP Contact Email(Required)

Number of Locations to be Serviced

Location 1

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Location 2

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Location 3

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Location 4

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Location 5

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

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