Internal Lead Form

Submission Made By:(Required)

Prospect Assigned to:(Required)

What prospect needs:

Company Name(Required)

Contact Number:(Required)

Main Contact Email Address:(Required)

Accounts Email Address:

If it's referred by our current customer, please indicate the name of the customer:

Others (please specify)

When is the best time to contact the client?(Required)

Please indicate the time and in what way can we contact the client (phone/email)

FOR ONE OFF - Kindly give a brief description as to what the client wants to avail:

Please indicate product wished to avail: