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Customer Inquiry form
Getting to know you, part one
Please answer these questions to help us get up to speed on your needs.
First Name
*
Last Name
Phone
Email
*
Country
*
Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Costa Rica
Côte d‘Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
French Guiana
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Northern Mariana Islands
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
What solution are you looking for? (e.g. – MES efficiency, Training eSign, Data Integrity)
Company Name
Facility Size
*
Select
1-5 people
6-50 people
51-200 people
201-800 people
801-1000
1000-3000
3000+
Industry
Medical Device Manufacturing
Pharmaceutical Manufacturing
Healthcare and Hygiene products manufacturing
Food manufacturing
Testing Centers or Schools
Hospital
Other
Supply Chain systems you use:
Körber Pharma/Werum IT PAS-X MES (3.1.8 or 3.2.x)
Rockwell FactoryTalk (aka PharmaSuite)
SAP
Siemens Camstar Portal MES
Tulip MES
Wonderware InTouch
Lonza MODA MES
N/A
Antares Vision
DeltaV
Other
Other
Training and Compliance
UL ComplianceWire
Cornerstone onDemand
Integral Training Tracking Tool
Other
N/A
Biometric Tech you are looking for:
Iris Biometric (Gloved/Aseptic – Touchless At-a-Glance
Fingerprint
Fingerprint/Finger vein
wearable/wrist band – always on auth
Windows Hello
RFID
Other
Timeframe for project:
Workstation Type (check off all that apply) For thin client, please provide some details below.
Thin Client
Windows 10
Windows 7 or other alt OS
Tablets
Clean room workstation – Systec or Arista type
Operating Environment
Questions / Comments
How did you hear about us?
Integral Staff
Interphex
Manupharma
Information Week
A friend
Colleague
Partner referral
Web Site
End User
Web Search
Other
Other
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