Lead Registration Form | EPIC Connections

This form is used by EPIC Connections to collect information needed to register sales leads. Please fill out the form as completely as possible.

Lead Registration Date

Master Agent Name*

Enter Master Agent name*

Partner Name (First and Last)*

Partner Company Name*

Partner Title

Partner Phone Number

Partner Email Address*

Partner Street Address

Partner City

Partner State

Partner Zip Code

Customer Contact First and Last Name*

Customer Company Name*

Customer Title

Customer Phone Number*

Customer Email Address*

Customer Street Address*

Customer City*

Customer State*

Customer Zip Code*

# of Contact Center Seats*

# of Employees

Current Contact Center Technology

Estimated Close Date

Service Needed #1

Enter Services Needed

Service Needed #2

Service Needed #3

Description of Opportunity

File Upload

Drop files here or

Please direct any questions regarding this form to Bill Pieper (bpieper@epicconnections.com) or 402-884-4700 x201.

Email address

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Name

This field is for validation purposes and should be left unchanged.