About Your Agency

Agency Name *

Agency Website *

About You

Submitter Name *

Submitter Role *

Submitter Email *

Submitter Phone

About the Client You're Registering

Client Name *

Client City, State *

Client Website *

Client Contact Name

Client Contact Title

Introduction Context *

When Do You Anticipate a Decision? * - Select -Within 30 daysWithin 90 daysBeyond 90 daysUnknown - too early to say

Acknowledgement

New client acknowledgement *

I confirm that this client is not currently a Fintactix customer, is not (to my knowledge) in an active Fintactix sales process, and has not previously engaged with Fintactix through inbound channels.

First in wins acknowledgement *

I understand that if two agencies register the same client, the first registration is the referral of record, and that registration provides a 90-day protection window from the date of approval.