Service Leads

Service Lead Submission

Must complete and submit all information requested below.

* denotes a required field

ALL REQUIRED FIELDS MUST BE FILLED OUT FOR YOU TO GET CREDIT.
DO NOT CALL YOUR AREA SALES REP WITH THIS LEAD.

New to the Service Lead Program? Please contact marketing@culliganquench.com for onboarding instructions and your training guide.


Technician Info
Tech Email*:	@culliganquench.com email address required
Tech Email Confirmation*:	Emails must match
*(Please use your @culliganquench.com email address only. Personal email addresses will not be accepted.)*
Company Info
Company*:
Work Order Number*:
Zip Code*:
Contact Info of the Lead
First Name*:
Last Name*:
Lead's Email*:
*(No Email? Use noemail@company.com, Do not use your Quench email or any email address that contains "@culliganquench.com".)*
Phone:
Notes for the Sales Rep: (Please include information about the product they are interested in and any other details you believe are important. Also note if there is a particular rep that should be involved)