Name:

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Title/position:

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Name of Company:

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Phone:

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Email:

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How many people would you like to participate on the introduction?

When would you like to schedule the introduction? Date and time ?

What would you say is your most pressing business issue?

What is the Company’s most pressing issue?

How many employees does your company have?

0-1000    1000-2000      Over 2000

What interests you in Process Improvement / Six Sigma?

Cost Reductions    Revenue Growth  
Improve Customer Experience
Culture Change       How to deploy
Specific Problem/other

What type of continuous improvement systems does your company use today?

None     TQM     Process Management
Lean      Workout      Six Sigma
CMMI     Other