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Intake form
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Name
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Email address
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What type of software do you need?
Please select at least one option.
Custom Application
Mobile App
Web Application
CRM System
E-Commerce Platform
What is your budget range?
Select
Under $5,000
$5,000 - $10,000
$10,000 - $20,000
Over $20,000
What is your timeline for the project?
Select
Less than 1 month
1-3 months
3-6 months
6 months or more
What industry is your business in?
Select
Healthcare
Finance
Retail
Education
Technology
Who will be the primary contact for this project?
Do you have any existing software or systems that need to integrate with the new solution?
Select
Yes
No
What challenges are you currently facing with your existing system?
Additional questions or comments
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