Consortium Introduction Form Consortium Introduction Form Your Information Your Name * Your Consortium ID Number (you can leave this field blank if you do not yet have your ID.) Your Introduction's Information Please fill in as many of the questions and information fields as possible. The more complete the information is for your Introduction, the better we can support them. Company Name * Company Website * Contact's First Name * Contact's Last Name * Contact's Middle Name Contact's Title * Contact's Responsibility * Contact's Direct Email * Company's Country * Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Northern Mariana Islands Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Yemen Zambia Zimbabwe Company's Street Address: * Company's Mailing Address (if different from street address) How long have you known this contact person? * How well do you know this contact person? * Contact's decision authority: * This Contact is the primary decision maker for my referral This Contact is one of two primary decision makers for my referral This Contact is one of three primary decision makers for my referral This Contact is one of many primary decision makers for my referral I don't know if this Contact is a primary decision maker for my referral Please provide a short description/overview of your Introduction's company. * Please list your Introduction's company's primary products/services. * What are your Introduction's company's Annual Revenues? * How many employees does your Introduction's company have? * How many locations does your Introduction's company have? * What is your Introduction's company best known for? * What specific Consortium tools and/or services have you discussed with this person? * Do you think your Introduction will purchase additional Consortium tools and/or services, and if so, which ones? * Is your Introduction's company a subsidiary or the parent company? * I would classify my Introduction as (check the most accurate selection): Not knowing about what the Consortium can do for them Not caring about what the Consortium can do for them Mildly interested in what the Consortium can do for them Very interested in what the Consortium can do for them Extremely interested in what the Consortium can do for them Does your Introduction's company currently have the funds to pay the Consortium? * Yes No I am not sure What is your personnal opinion about what the Consortium’s tools and/or services will do for your Introduction? * What Consortium materials have you given to your Introduction? * Introductory Email or Letter Consortium Brochure One-Paragraph Introduction to the Consortium Due Diligence, Inc. Order Form Consortium Catalog of Publications Other Documents What does your Introduction want to accomplish using Consortium tools and/or services? * Has your Introduction voiced any questions you could not answer? If so, what are the questions? * Contact you have had with your Introduction (check all that apply): * Never Spoken Spoken With Once Spoken With Twice Spoken With Three Times Spoken With Many Times Never Met Met With Once Met With Twice Met With Three Times Met With Many Times How soon does your Introduction want to purchase any of the Consortium's tools or services? * Immediately 1-2 Days 3-5 Days 1 Week 2 Weeks 3 Weeks 4 Weeks More than 4 Weeks I am not sure when they will purchase any Consortium tools or services Did you make any promises to your Introduction and if so, what are the promises you made? * Please upload your Introductory Email or Letter you gave to your Introduction. 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