Test- Client and Contact Change Form

Account Manager*

Account Manager Email*

Type of Change*

Type of Change

Contact
Address
Client Name
Acumatica ONLY - Add/Remove Recipients

** This option should only be selected if it DOES NOT affect EAP Expert contacts or if you are updating billing contacts for an entire consortium in Acumatica.

Client Name*

Does this change apply to additional verticals/accounts or only the one named above?*

Does this change apply to additional verticals/accounts or only the one named above? (changes that are different between verticals/accounts need to be submitted separately)

Additional Verticals/Accounts
Only named account above

Additional verticals/accounts to change (separate multiple accounts with a comma)*

Old Name*

New Name*

Alias

Does this affect all contacts including billing?*

Does this affect all contacts including billing?

Yes
No

** Do a contact change so you can specify who the address update is for unless this is a billing address change only.

Update Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

What is changing?*

What is changing?

Adding New Primary Contact
Adding New Secondary Contact
Removing a Secondary only
Update an existing contact's info (enter name and only info that is changing)
Adding a new broker
Changing a broker

Previous Broker Name

Broker Name

New Broker Name

Broker Address

Street Address Address Line 2 City State ZIP Code

Broker Phone

Broker E-mail Address

Do you want this broker to receive communications?*

Do you want this broker to receive communications?

Yes
No

Is there a broker contract in place already?

Yes
No

Do we need a broker contract?

Yes
No

Are they getting a commission?

Yes
No

What is the commission percentage? (enter the number only)

Is update for primary or secondary contact?*

Is update for primary or secondary contact?

Primary
Secondary

Original Name*

New Name

Title

Update Office Phone

Update Cell Phone

Update Fax

Update Email

Update Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is current primary contact no longer with company?*

Is current primary contact no longer with company?

No longer an employee
Still with company, move to secondary contact
Still with company, (Remove from EAPX and Client Lists, but add back in communication program if client has maintenance)

Remove Primary Contact Name

Remove Primary Contact Email

Is this brand new primary or move from secondary*

Is this a brand new primary contact or are you moving a secondary contact to primary?

New Primary Contact
Move a secondary to primary

New Primary Contact Name*

New Primary Contact Name

Title

Office Phone

Cell Phone

Fax Phone

Email*

Is current primary address listed in EAPX correct?*

Is current primary address listed in EAPX correct?

Yes
No

Address*

New Primary Contact address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reason for change?*

Reason for change?

Just adding a new secondary contact
Replacing an existing secondary contact

Remove Secondary Contact Name*

Remove Secondary Contact Name

Remove Secondary E-mail

Is secondary contact no longer with the company?*

Is secondary contact no longer with the company?

No longer an employee
Still with company, not in contact role (Remove from EAPX and Client Lists, but leave in Maint list if client has maintenance)

New Secondary Name*

New Secondary Name

Secondary Title

Secondary Phone

Secondary Cell

Secondary Fax

Secondary Email*

Address same as primary in EAPX?*

Is address same as primary in EAPX?

Yes
No

Secondary Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you need to add another secondary contact?*

Do you need to add another secondary contact?

Yes
No

Do you need to remove another secondary contact?*

Do you need to remove another secondary contact?

Yes
No

Secondary Name #2*

Secondary Name #2

Secondary #2 Title

Secondary #2 Phone

Secondary #2 Cell

Secondary #2 Fax

Secondary #2 Email*

Is secondary contact no longer with the company?*

Is secondary contact no longer with the company?

No longer an employee
Still with company, not in contact role (won't be in EAPX, but could be in a communication program)

Is this contact address same as primary in EAPX?*

Is this contact address same as primary in EAPX?

Yes
No

Secondary #2 Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you need to add a 3rd secondary contact?*

Do you need to add a 3rd secondary contact?

Yes
No

Do you need to remove a 3rd secondary contact?*

Do you need to remove a 3rd secondary contact?

Yes
No

Secondary #3 Name*

Secondary #3 Name

Secondary #3 Title

Secondary #3 Phone

Secondary #3 Cell

Secondary #3 Fax

Secondary #3 Email*

Is secondary contact no longer with the company?*

Is secondary contact no longer with the company?

No longer an employee
Still with company, not in contact role (won't be in EAPX, but could be in a communication program)

Is 3rd contact at same address as primary?*

Is 3rd contact at same address as primary?

Yes
No

Secondary #3 Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Acumatica Updates Below

Does the new primary contact need to be included on the email recipient list for contracts and invoices?*

Does the new primary contact need to be included on the email recipient list for contracts and invoices?

Yes
No

Do any of these secondary contacts need to be included on the email recipient list for contracts and invoices? (Can select multiple)

None of them need to be added
Add the 1st Secondary
Add the 2nd Secondary
Add the 3rd Secondary (if applicable)

Does the new secondary contact need to be included on the email recipient list for contracts and invoices?

Yes
No

Does the new broker contact need to be included on the email recipient list for contracts and invoices?

Yes
No

Please check the list of contacts in Acumatica before making your selection below:

The new primary contact will replace the recipient being removed on this form
Add the new primary contact in addition to any other recipients that are in Acumatica
The new primary contact will replace a recipient that is not listed on this form

Email address of recipient to be replaced

Do you need to update the contract and invoice recipients for an entire consortium?

Yes
No

What is the name of the Parent Company where contracts and invoices are sent?*

What is the name of the Parent Company where contracts and invoices are sent?

Client Name*

Client Name

What is the Acumatica Parent ID # that ends in 01-01?*

What is the Acumatica Parent ID # that ends in 01-01?

How do the contract and invoice recipients need to be updated?

Add new CC recipient/s
Remove recipient/s
Replace a single recipient with a new recipient
Replace ALL recipients with new recipient/s indicated below
Make a one time request that the upcoming contract and invoice be sent to me rather than recipients on file

Remove Recipient Email/s

New Primary Recipient Name & Title

First Last

Job Title

New Recipient Name

First Last

Job Title

Email Address*

Email Address

Phone Number

Add CC Recipients?

Yes
No

Name of Recipient to CC

First Last

Email Address*

Email Address

Name of 2nd Recipient to CC

First Name Last Name

Email Address

Does this change the billing address ONLY?

Yes
No - Go back and select "Contact Change."

Update Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Does the unique address indicated for this contact need to be updated as the address on the client's invoices?

No
Yes

Additional Information for Acumatica

Test – Contact Change Form

Acumatica Updates Below

6 Important Reasons to Upgrade to an ESI EAP

To better serve you, please choose an option below:

I am a current employee/family member of ESI EAP seeking services for myself

I represent an employer seeking a quote from ESI EAP for an organization.

Help for Employees