Referral Partner Center:

Referral Partner – Lead Registration Form

Please complete and submit this Lead Registration Form for each lead. This form registers the lead with ACOM, and ensures that the referrer is acknowledged as the source and owner of this lead. If lead is not registered with, or has not been in contact with ACOM within the last 6 months, ownership of the lead will belong to your company.


Items with an (*) must be completed for proper submission

Referral Partner Information

Sales Person's Name:*

Your Company Name:*

Phone:*

E-mail:*
 
 

Lead Referral Information

Company:*

Contact Name:*

Title:

Phone Number:*

E-mail:*

Address:

City:

State/Province:

ERP/Financial/Accounting System in use

May we contact this client?

Product(s) of Interest
Document Management (electronic archives/routing for approval)

Payment Processing (Electronic payments/notifications, laser checks)

Business Form Templates/Overlays

EDI/XML

Other:

Questions or Comments?