Pre-Sales Form

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PRE SALES INFORMATION REQUEST FORMSend Us Your Request

Name of Organization*

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Physical Address of Organization*

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How long has your company been operating?*

Drag to the right for number of years

What Insurance Application System is in place?*

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Key Executive Name*

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Designation*

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Key Executive Name

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Designation

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Its Short Comings?

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What do you hope to achieve with a new system?*

Business expectations

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Size of Your Organisation*

Estimate number of concurrent users

Distribution Channels*

Number of branches / agent offices

Timelines to acquire new system?*

Indicate possibility

Immediately

1 Month

6 Months

12 Months

More than 12 Months

Estimate Budget?*

In United States Dollars

$100 - $500

$500 - $1,000

$1,000 - $10,000

$10,000 +

Contact Person*

Fullname

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Email Address

Contact Number*

Office or mobile

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