New opportunity registration and information update form:

This data entry form is for the specific use Gemba Solutions Distributors, Re-seller, SI and implementation partners to register and update activities with prospective or existing clients. Information submitted on the form will be held in a secure database at Gemba Solutions offices.

Fields in bold must be completed


Partners Details
Your Company Name :
Your Name :

Client details (if the contact and company have been previously registered with Gemba then only enter contact and company fields)
Contact :
Company:
Address 1
Address 2
Address 3
City/Town
County/State
Zip/Post
Country
E-mail
Tel
FAX
Notes (please enter notes here)

Note: We are committed to protecting your privacy and will use any information provided by you lawfully and in accordance with the data protection act. Whilst those details will be stored in our secure database they will not be passed on to an third party. To view your details or have them removed from our database please contact us by phone or email.