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Request Information

Use the "Request Information" form to ask COINS USA Sales for information about COINS USA products such as COINS Ti, or for information about COINS USA services.

If you are already a COINS USA client, please use the Support Call form instead of this form.

1. What product or service areas are you interested in learning more about? (Check all that apply)

	Accounts Payable		Production Tracking
	Accounts Receivable		Project Management
	Business Intelligence and Integration (BI²) Database		Purchase Order/Inventory
	Construction Billing		Safety Management
	Equipment		Sales Order Processing
	General Ledger		Service Billing
	Human Resources		Service Management (S/M)
	Employee Benefit Tracking		S/M Call Management System
	Job Status		S/M Mobile Technician
	Mobile Solutions		Subcontract Control
	Payroll		Time and Attendance Tracking
	Point of Sale		Union Payroll

	Consulting and Training		Report Writing
	Integration with 3rd Party Software		Support Center Services

Other - please specify
For example, "Request an online demonstration of..."

2. How can we get in touch with you?
* = required information

Name:*
Title:*
Company:*
Address:
City:
State:
Zip:
Phone Number:*
Fax Number:
E-mail Address:*

3. Let us get to know you better:

Type of Business:

	Specialty
	Heavy Highway
	General Contractor

Number of Employees:

Annual Revenue ($million):

	$0-10
	$11-25
	$26-40
	$41-70
	$70+

4. How did you hear about COINS USA?:

	Magazine ad		Referral
	Trade show		Web research
	Through a mailing		Other

5. Tell us what you think. We invite your comments, suggestions, or additional questions in the space below:

Please contact me as soon as possible.