Where can we assist you? (Check all that apply)

• Softium marketing program
  Product
  Investment
  Technical Support
  Career
  Partnership
  Other -
  

How did you hear about Softium? (Check all that apply)

• Ad
  Press release
  Referral
  Trade show/Seminar/Conference
  Other -
  

Professional Information

First name Last name
Company
Address 1
Address 2
City State Zip Code
Direct Phone
E-Mail

Are you currently a Softium customer?

• Yes No
  

Are you currently considering the purchase of a Softium Product?

• Yes No
  

Is budget approved for your purchase?

• Yes No
  

What is your forecasted software budget?

• $3,000 - $29,999 $30,000 - $99,999 $100,000 - $999,999 $1,000,000 +
  

What is your time frame for deciding to buy?

• 0 - 2 months 3 - 6 months 6 - 12 months 1 year +
  

What is your role in the decision making process?

• Recommender Evaluator Approver Actual buyer
  

Can we e-mail you product offerings and promotions?

• Yes No