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New Client & Current Client ACH Updates
Please direct any questions on this form to Carter and Tom Dang
Client Information
Client Name:
Official Client Name:
Client Billing / Address:
Street Address:
Street Address 2:
City:
State:
Zip Code:
Tax
Federal Tax Employer Identification Number (EIN):
ACH Information
ABA Routing Number:
Recipient Account Number:
Account Type:
(select one)
Checking
Savings
Contact Email (for statements):
Is this a Nancy Watkins Client?:
No
Yes
Hosting and Setup Information
Setup Fee:
$ 400
Waived
Other (enter amount)
Setup Fee Other Amount (If Necessary):
Hosting Fee:
$ 25
Waived
Other (enter amount)
Hosting Fee Other Amount (If Necessary):
Will this client be billed hourly or have a retainer?:
Hourly
Retainer
n/a
If client will be billed, what is the hourly rate or retainer (including # of hours included in reainer)?:
eDonation Information
Type:
eDonation 1
eDonation 2
Rapid Donation
Other
Unsure
Other Type:
Is this a "cost plus" customer?:
Yes
No
Main %:
Processing / Events %:
Revenue Share %:
If this is NOT a "cost plus" customer, please provide details:
Staff Information
Staff Member responsible for this Client:
Notes / Special Instructions:
Contract:
Processing...
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