One of the main tasks of key account management (KAM) practice is the creation of customized value propositions for a business-to-business organization's most important customers, which often requires the support of multiple internal departments. Thus, making internal alignment central in KAM in order to exchange value and serve the key accounts (KA) long-term. This study will, therefore, explore internal alignment in KAM and aims to identify what contributes to internal alignment and how misalignment could emerge in KAM teams, in order to understand the significance of internal alignment and identify possible reasons for misalignment in KAM. The theory was framed by 7 elements of internal alignment including shared values, style, skills, staff, strategy, structure and systems. The empirical data was collected through qualitative semi-structured interviews with KA managers. The findings suggest that internal alignment is of importance in KAM and that the elements of internal alignment studied in the thesis are dependent on each other. Furthermore, it was found that misalignment is most commonly caused by personal disputes, however, all elements studied were found as contributing factors to misalignment. The findings led to the conclusion that internal alignment is not a target state, it is rather a measure of progress and that all aspects that do contribute to internal alignment also entail causes for misalignment.