New Client Intake Form

If you prefer to provide this information over the phone, we can gladly do so, however, to save time and to enhance the accuracy of the information, it is always better to use this form instead.

 

Our New Client setup process is fairly simple:

1. Fill out the form below – Scroll down on this page to find it.

2. Sign our Master Service Agreement and Cyber Incident Release Form (That form will show up on the next page, once you fill out and submit the below forms).

3. Wait for our Billing Portal’s “welcome email”- It is normally sent on the same or the next business day.

  • Our billing portal is where you will be asked to enter your payment information (Credit Card or ACH).
  • We require a payment method on file from all our clients.
  • More information about our billing portal can be found HERE.

Once the above 3 steps are completed, you will be officially registered on our end, and will be eligible to request support from our team!

Additional forms we might request from you down the road:
(you do not need to fill these up, unless asked to do so)

  1. User list collection sheet
  2. Technical questionnaire

If at any point you have any questions, please Email us at admin@GallopTechGroup.com, or contact our team via phone. We’re always happy to help!

Company Name *
Company Address 1 *
Company Address 2
Company City *
Company State *
Company Zip *
Company Phone *
Company Alternate Phone
Company Web Site
Company Market Segment *
Company Lead Source (Referral) *
Company Number of Employees *
Your First Name *
Your Middle Initial
Your Last Name *
Your Title *
Your Work Phone *
Your Phone Extension
Your Mobile Phone
Your E-Mail Address *

Gallop Technology Group will be using the cell phone number to send you urgent notes from our engineers, and potential security codes. No marketing or group messages will be sent via SMS. Message and Data Rates may apply based on your cellphone plan. At any point, you can reply to our SMS messages with HELP for help and STOP to instruct us to use Email instead. Initially, a cell phone number is required for security reasons.