A-Biotech A-Biotech Lead Submission Form Please fill out the following form to secure business to your customer. All submissions are time stamped and will be verified as original leads by Implen. Your entries are automatically converted to a spreadsheet which can be used for follow-up and forecasting. Feel free to make any changes to the spreadsheet such as notes or sales funnel stage. Implen maintains a backup of entries with time stamp.Sales Rep Name* Customer First Name* Customer Last Name* Title*Dr.Prof.Mr.Ms.Mrs.MissPosition* PI Lab Manager Postdoc Grad Student Tech Other Company/Institution* Institute* Lab/PI Name* Street Address*Street Address including Mail Code or Lab Location City* Postal Code* Country* Lead Source*VisitAdvertisementExhibitionColleagueBlogGoogleWebshopProduct of Interest* N120 NP80 N60 N50 C40 CFR21 Software Competitor(s)* Additional NotesCustomer needs, purchasing time, etc Please confirm that Implen is authorized to store your information and use it according to our privacy guidelines. You may recall this authorization at any time, please contact our support team to do so.Consent* I consent to having Implen store my information
