Financial Services -
  Unrestricted Accounting & Reporting

New Customer Setup/Change Request

Contact Information

Name: *
Email Address:
  (i.e. jdoe@salud.unm.edu)		 *
Department:
Telephone:

Request Type

Option 1: New Customer
Customer Name:
Attention (if any):
Billing Address:
City:
State:
Zip:
Option 2: Change/Modify Customer
Customer #:
  (must begin with Y)
Please print this form out before you hit "Submit" for your own records.

* - Required Fields