Intake Form | Blennd

/ New Client Intake Form

Please fill out the new client contract and accounting profile information below to request a services agreement and get started working with Blennd.

"*" indicates required fields

This information will be represented in the services agreement, please make sure it is legally accurate.

Signer First Name*

Signer Last Name*

Signer Title*

Signer Email Address*

Legal Business Name*

Today's Date*

Legal Business Street Address*

City*

State*

Zip Code*

This information will set you up in the Blennd accounting system.

Primary Contact First Name*

Primary Contact Last Name*

Primary Contact Email Address*

Primary Contact Phone Number*

Brand Name (Public Facing Brand Name)*

Blennd Primary Point of Contact*

Invoice Recipient(s) Email Address (separate by commas if more than one)*

Phone

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