First Name    
Middle Name  
Last Name     
Phone numbers(s)
Email address        

Company Name  
Street Address 
City                   State    Zip Code 

Contacts

Name:                                     Phone Number            E-Mail Address                         Yrs known
   
   
   

How do you know this person or company?

Why do you consider them a good prospect?

Please choose your preferred plan of action:

Option 1 - I prefer to contact the prospect and introduce them to the Docstar Imaging System.

Option 2 - I would like to coordinate an appointment with the prospect and Crystal Clear Solutions and attend the first meeting.

Option 3 - I prefer to supply the referral and let Crystal Clear to follow up on this lead.

Commissions are based on participation and product knowledge.