Company Name Address 1 Address 2 City / Town State / Province Zip Code Country
Your Need Select Level with Time Frame... Grave - Loss of Life Catastrophic - Loss of Health Critical - Operations Adversely Affected Marginal - Inconvenience or Annoyance Negligible Immediate Near Term Long Term Other
Budget Select your budget... less than million million to million million to million million to million million to million million to million million +
Company Size Number of employees... 1 to 5 6 to 15 16 to 49 50 to 99 100 to 249 250 to 499 500 to 999 1,000 to 4,999 5,000 to 9,999 10,000 to 24,999 25,000 to 49,999 50,000 to 99,999 100,000+
Industry Select all that apply... Non Profit For Profit Hospital Health Services Medical Supplies Medical Equipment Medical Distribution University Research Aerospace Consulting Education Government Manufacturing/Industrial Manufacturing consumer goods Financial/Banking/Insurance/Real Estate/Legal Retail/Wholesale Publishing/Broadcast/Media VAR/VAD/Systems or Network Integrator Other
Role Select all that apply... Determine Need Evaluate products/services Recommend and specify products/services Implement products/services Technical decision maker Financial decision maker Other decision maker Other
Responsibilities Select all that apply... Research and Development Engineering Doctor Nurse Physician Assistant Other Health Care Provider Health Care Administrator Health Care Role Product Development Manufacturing Distribution Training Marketing Sales Purchasing Shipping Project Management Profit Loss Accounting Finance Management of Outsourcing Other
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Cassbeth Inc.