Declare a lead - Cegedim Business Services

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1 - About the partner

The fields with * are mandatory

Partner's name *

Sales contact's name *

Sales contact's first name *

Email *

Phone *

Lead source *

Specify the origin of the lead *

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The fields with * are mandatory

Company name *

SIRET number *

Activity *

Group affiliation

Address *

Staff by month *

CCN (IDCC number)

Is this one of your clients? *

On what scope

Contact name *

Contact first name *

Former user of our solutions *

Position *

Add a contact

Contact name *

Contact first name *

Position *

Add a contact

Contact name *

Contact first name *

Position *

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The fields with * are mandatory
This confidential information will only be shared with the partner and the supplier

Current solution(s) *

Reason for the change *

If AO, desired response date

Target production deployment date *

Target contract date *

Is there an AMOA?*

Name of the firm *

Names of known competitors

Detailed description of the lead's context *

I accept that my personal information entered may be used for the purpose of contact.

Consult the data protection policy.