B2B Customer Entry Form

Details we need from you (Referrer)

Your Business Name(Required)

Name(Required)

Your Email(Required)

Who you are referring (Customer)

Client Name(Required)

Client Organisation(Required)

Client Role(Required)

Client Phone Number(Required)

Client Email Address(Required)

Estimated Number of Installations Required(Required)

Please enter a number greater than or equal to 0.

Total Fleet Size

Please enter a number greater than or equal to 0.

Required Project Start Date(Required)

Permission to contact(Required)

Yes

No

Please confirm that you have permission for Indra to contact

Notes

Please use the space below to provide any additional information.

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