Request

REQUEST

	If you would like to speak to a representative, please call us during business hours (Monday-Friday 9 AM to 5 PM EST/EDT). Or you can fill in the information below and click the Submit button. *( indicates a field that must be filled in)**

FIRST NAME
MIDDLE INITIAL
LAST NAME
TITLE
DEPARTMENT
OTHER
COMPANY NAME
ADDRESS
CITY
STATE
COUNTRY
ZIP/POSTALCODE
PHONE
FAX
EMAIL ADDRESS
# OF EMPLOYEES
# OF LOCATIONS

	Completing the following optional information will help us provide you with the best solutions for your needs

	Type of Business

	Manufacturing	Financial Services
	Healthcare	Not for Profit
	Government	Higher Education
	Hospitality	Retail
	Manufacturing Distribution
OTHER

	Application Interest(s) (Please see our products page)

	Integrated Fund Accounting	Correspondence Tracking
	Membership Management	Invoice Tracking
	Community Based Project Mgmt.	Complaint Management System
	Document Imaging and Management	Alumni Donor Management
OTHER

	Products and Services Interest(s)

	Application Development	Web Application Integration
	Develop Online Help Systems	SQL Server Administration
	Help Desk Support	Database Engineering
	Oracle™ Administration	Software Engineering
	Office Suite Integration	Network design
	Novell Networking	Unix or NT Networking
	Fire Protection Services	Wireless Networks

	Operating Platform

	A/S400	Client/Server
	Novell	Macintosh
	UNIX	Windows (XP, 2000, NT, 98, 95)
OTHER

	ERP System


OTHER

	Where did you hear about our web site? If possible, please provide the telephone extension number from the mailer, article or advertisement (this is the extension number listed after the toll free number)

	Nu-Pulse mailing	Ext.
	Magazine article	Ext.
	Nu-Pulse advertisement	Ext.
	Internet search, which engine?	Ext.
	Referred by a friend or colleague

	When Should We Contact You?


OTHER

	When are you planning to purchase a product?


OTHER

	I prefer a NetMeeting demo
	Send me a demonstration CD

	Additional comments or questions