New Customer Onboarding Form | americanfireshield.com

First Name

Last Name

Phone

Name of Business or Location

Would you be open to granting after-hours access via a lockbox or door code?

Lockbox Door Code N/A

Lockbox or Door Code

List Preferred Days of the Week and Times for Service:

Select Method of Payment:

ACH or Bank Transfer (0% Fee) Credit / Debit Card (3% Fee) Check ($39.99 Paper Handling Fee)

Routing Number

Account Number

Credit/Debit Card Number

Expiration Date

CVV

Billing Zip Code

Credit Card Authorization

I authorize American Fire Shield to process payments using the credit/debit card information I have provided. I agree that upon completion of the approved services, American Fire Shield may charge my card for the amount agreed upon in the provided quote. I understand that this authorization remains in effect until I provide written notice of cancellation. I acknowledge that any disputed charges must be addressed within the terms outlined in my service agreement.

ACH Authorization

I authorize American Fire Shield to process payments using the ACH information I have provided. I agree that upon completion of the approved services, American Fire Shield may initiate an ACH transaction for the amount agreed upon in the provided quote. I understand that this authorization remains in effect until I provide written notice of cancellation. I acknowledge that any disputed charges must be addressed within the terms outlined in my service agreement.

Write Full Name for Signature

Is your billing information different from your service location(s)?

Yes No

"Bill To" Company Name

Bill To Address

Corporate Phone

Corporate Email