Personal Information
	Title:
	First Name:	*
	Last Name:	*
	Job Title:
	Email Address:	*
	Contact Number:	*
	Company Information
	Company Name:	*
	State:	*
	Country:	*
	Industry Type:	Professional Services Financial Services Manufacturing Construction and Real Estate Logistics/Distribution Retail Other
	No. Of Employees:	<25 26 to 50 51 to 100 101 to 150 151 to 200 201 to 250 251 to 500 501 to 1000 1000 plus
	Key Business Needs
	Please select your primary business needs:	Improved financial processes and management Integrating functionality and data entry Accurate demand forecasting Accurate real time reporting Meeting regulatory and compliance requirements Rapid turnaround, high levels of responsiveness
	Information On Your Current System
	ERP/Financials/Distribution/Manufacturing:
	Payroll System:
	Current infrastructure (Vendor, O/S):
	Database:
	Timeframes
	Please select your anticipated timeframe:	Implement during next 3 months Implement during next 6 months Implement early 2007 Not known
	How would you like Fusion5 to contact you?	Phone Email
	Would you like to receive promotional material?	Yes No