Lead Opportunities Submission Form
Territory Manager:
*
TM E-mail Address:
*
TSS Name:
*
Please Select
Ashlee Franks
Bryane Wolfgang
Casey Mulberry
Chris Breazeale
Danielle Ketchum
Eric Omlin
Krisha Smith
Mark Cassimatis
Matt Zumbro
Michelle Periko
Terry D'Amelia
Zachary Melton
I Don't Know
Person Submitting:
Submitters Email:
Provide if you'd like a confirmation email for this submission
Full Clinic Name:
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Account Number:
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Lead Opportunities
Please indicate each opportunity and provide relevant additional information
Whole Body X-Ray
Customer is interested in:
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Sound
Sedecal
I Don't Know
Customer services:
*
Large Animal
Small Animal
I Don't Know
Have discussed the following:
Notes:
Reference Lab - Antech
Notes:
Ultrasound
Customer is interested in:
*
Sound
Butterfly
Notes:
In House Lab
Customer is interested in:
*
VS2
VSPro
Vetscan SA
HM5
Imagyst
I-Stat Alinity
I Don't Know
Current Lab:
Notes:
Laser
Customer is interested in:
*
Sound
Companion
I Don't Know
Notes:
Structural (Casework, Runs, Cages)
Customer is interested in:
*
Midmark
VSSI
Mason
Suburban
I Don't Know
Notes:
New Practice
This is a:
*
New Construction
Remodel
I Don't Know
Notes:
Inventory Management - Vault
Notes:
Emerging Technologies
Customer is interested in:
*
CT
MRI
C-Arm
I Don't Know
Notes:
Dental X-Ray
Customer is interested in:
*
Midmark
Dentalaire
I Don't Know
Notes:
MWI Financial Solutions (Commitment Programs)
Notes
Financing
Customer is interested in:
*
12/24
Bank of America
Lease
I Don't Know
Notes:
Other
Notes:
*
Lead Source
*
Submit
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