Client Intake – BCU Certified

New Client Information

Please help us create the best experience possible by completing the information on this form.

Client Intake Form

Company Name

Company Type:

Other (Company Type)

Company Website

Address

City

State

How Many People From Your Organization Would You Like to Empower with Our Training Platform?

Total Size of Your Organization (Include all groups, i.e. students, faculty, staff, executives, etc.)

What Group from Your Organization Will Use Our Platform Most?

Other Group (Describe)

Any existing online training?

Please specify what kind

Current Annual Training Budget?

Goals for training? (multiple choice options)

Name and Title of Decision Maker

First Name

Last Name

Title

Name of Contact Person (if different from Decision Maker)

Contact Number

Contact E-mail

How soon would you like to get started?

Any additional comments: