Name of Company
Position at Company
Phone number with extension
What is the contact information for your company (email address/webpage)?
Have you ever previously used an LZI reagent before? If yes, then who did you purchase them from?
Have you ever resold/distributed an LZI reagent? If yes, then who was your supplier?
How did you hear about us?
Who is your current supplier and why do you wish to switch to us?
What type of company are you and what type of customers do you serve?
What instruments do you use?
What products are you interested in and in what testing volume?