*
Salutation:
--None--
Mr.
Ms.
Mrs.
Dr.
Prof.
*
First Name:
*
Last Name:
*
Title:
*
Company:
Website:
*
Email:
*
Phone:
Fax:
Address:
City:
State/Province:
Zip:
Medical staffing Type (PRN, Travel, etc):
Number of employees that would use TSS:
Number of offices/locations:
Approximate size of resource pool:
Do you currently use staffing software:
Yes
No
If yes, what software:
Integration with payroll & accounting:
Yes
No
Unsure
If yes, what system(s):
Type of internet connection:
T-1
DSL
Cable Modem
ISDN
Dial-up
Other
Preferred way to contact you:
Via Telephone
Via email
Do you have a preferred demo date:
Planned software implementation date:
Current payroll cycle:
Daily
Weekly
Bi-weekly
Other
How did you hear about TSS:
ASA Tradeshow
ASA Print Ad
Staffing Industry Analysts Tradeshow
Web Search
Direct Mail
Referred by current client
Email you received
Additional Information:
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