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CUSTOMER INTAKE FORM

CUSTOMER INTAKE FORM

Please fill out the details below. Alternatively, you can email us at: info@fleurysolutions.com
All fields marked with an asterisk () are required.*

Company Information

Company Name*

Company phone*

Company email*

Business Domain

Company Tax ID

Company Address*

Point Of Contact

POC Name*

POC Phone*

POC E-mail*

Project Information

Brief Description of Project/Service

Budget

Deadline

* I confirm that I have read and agree to our standard T&Cs available at fleurysolutions.com

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