First Name *

Last Name *

Role /Title *

Email *

Phone *

Mobile Phone *

Company Website *

How Long Have You Been In Business? *

Company Size *

2-10
11-25
26-50
50+
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# of Active Monitoring Accounts *

What is your current MONTHLY sales revenue? Ballpark. *

0 to $10k/mo

$10k - $25k/mo

$25k - $50k/mo

$50k - $100k/mo

$100k - $250k/mo

$250k/mo - $500k/mo

$500k - $1M+/mo

Primary Area / Territory *

Do you currently offer water-related monitoring products? *

Watr Leak Sensors

Smart water shutoff

WiFi water alarms

None yet

Expansion Goals

How Many New Customers Can You Handle Right Now? *

1-10

11-20

21-30

30+

How many customers would you like to ad in the next 12 months *

50
100
500
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How many customers would you like to add in the next 5 years *

100
500
1000
2500
5000+
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Do you currently have the staff to handle your 12 month goal *

Yes
No
I will need to hire accordingly
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How soon are you looking to add a new revenue stream? (Like Qixli) *

Within the next 6 months
6-12 months
1 year+
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Anything else we should know?

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