SERVICE REQUEST FORM
EXCIPIENT
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Client Name *
Company, business or individual name
Client Representative
If Client above is an individual leave blank for businesses and companies, include name of person representing said business or company.
Select appropriate description of beneficiary *
Mobile Number *
Email address *
General description of project *
PLATFORM *
Required
How many apps or modules will be project be?
 *
AVAILABILITY *
TYPE *
Choose the option that best describes the product.
PAYMENT STRUCTURE *
Subscription payment is meant to ease the cost burden of product of the client but will attract higher fee.
SUPPORT *
Note that bug fixes and support for OS revisions and support for new web standards for one (1) year comes bundled for free.
Desired Launch Date *
MM
/
DD
/
YYYY
OUTLINE KEY FEATURES
 *
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This form was created inside of Logic Gate Capital.