Customer Lead and Qualification

Customer information and company profile / product use and budget survey.



   
Please indicate which of the following products you own:
Company
Yes No
Product 1
Product 2
Product 3
Product 4
Product 5
Product 6
Product 7
 
   
 
PURCHASE HISTORY

Please indicate when you last purchased a [Company] product?
 
0-3 months ago
 
3-6 months ago
 
6-12 months ago
 
12-24 months ago
 
24+ months ago
 
   
 
PRODUCT INTEREST

Please indicate the types of products you may be interested in purchasing or learning more about:
 
Product 1
 
Product 2
 
Product 3
 
Product 4
 
Product 5
 
Product 6
 
Product 7
 
Other
    
 
   
 
To help us serve you better, please tell us about your business:

Number of employees at your site:
 
1-100
 
101-250
 
251-500
 
501-1000
 
1000+
 
   
 
Annual budget for this product category:

 
$0-$10K
 
$10K-$50K
 
$50K-$100K
 
$100K+
 
Other (Please Specify)
    
 
   
 
Are you the person responsible for updates/purchases?
 
Yes
 
No
 
   
 
Is there another person in your organization who is responsible for purchasing [Product Class] or services?

Name
   
 
   
 
Title
   
 
   
 
Phone
   
 
   
 
Email
   
 
   
 
Thank you!
 
   
 
Permission to contact you via e-mail?
 
Yes
 
No
 

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