| Today's Date: |
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| Primary Role: (Select One) |
Staff Member |
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Sales Person |
| User Name: * |
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| Phone & Extension: * |
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| Sales Region: |
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| Computer Assignment: * |
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| Reports To: * |
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| Select Location: |
Canton Location |
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Phoenix Location |
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Remote User |
| Email Name (If not standard format): |
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| Email Options: Select all that Apply |
Blackberry
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Outlook
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Include on Derek's Outlook
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Add to the Following
Distribution List(s):
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| Applications: Select All that Apply |
ACT
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Advance Pro
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QuickBooks
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Scanning
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Time Force
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VPN / Remote Access
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| Special Instructions: |
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| Request Service Confirmation via email To: |
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