Prospect Registration

Dealer*

Rep First Name*

Rep Last Name*

Rep Phone*

Rep Email*

Company Name*

Prospect First Name*

Prospect Last Name*

Address*

City*

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Tel*

Prospect Email*

Date of Sales Pitch*

Products Pitched*AvengerAvenger PLUSClipper IIChallengerLiberatorBlasterTerminatorFlipperEliminator

Those in attendance*

Notes about the pitch

Likelihood of closing deal*Choose %10%20%30%40%50%60%70%80%90%100%

Date of expected sale*