Customer Application Form

mPower Global Inc

Customer Application Form

Filling out the form completely will provide us with the information to understand your design goals effectively & assess your support requirement

Company and Contact Information

Name*

Company Name*

Address*

City*

Country*

Region*

Zip Code

Work Phone

Fax Number

E-mail Address*

What is your team size?*

Project Name*

Office Location*

Design Resource & Project Information

If you already have a web portal, what are the areas of improvement?

How are you currently handling the process of maintaining the web portal?

Are you researching for a client, or is this requirement for your own company?

Could you describe your role?

What type of Industry do you/your client compete in?

When would be a good time for our account executive to contact you?

When are you planning to choose a solution?

When do you expect to go live with the solution?

What other solutions have you considered?

Project Time Line*

Project Start Date*

Previous Year IT Budget

Current Year IT Budget

Do you have a development lab?*

Yes No

How did you hear about mPower?