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Surveypal Lead Referral

Please use this form to submit a new sales lead to Surveypal, and to indicate that you want to be considered entitled to the agreed referral fee. Surveypal will check that this is in fact a new customer, and contact you to confirm your right to the fee.

Customer organization

Customer ID (tax ID etc)

Country

Customer Contact Person

Customer Name

Customer Telephone Number

Customer Email Address

Description of customer's current situation and needs

Referrer Details

Your Company's Name

Your Name

Your Email Address