NEW SYSTEM CUSTOMER QUESTIONNAIRE

Name

Phone #

E-mail

ACCOUNTS PAYABLE CONTACT

Name

Phone #

E-mail

I.T. (TECHNICAL) CONTACT

Name

Phone #

E-mail

Do you have internet access? Yes No

If YES how many users

Access to the Internet at their workstation? Yes No

Would you like everyone to login and order from their station? Yes No

If NO from one station? Yes No

Please list First name & last initial of users if applicable. This is to enable client on-line ordering & delivery tracking- Internet login access.

(One username per line please)