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   Title                    
* Contact Name
* Organization Name
* Email
* Phone
* Address
* What is your primary business area ?
   Do you currently have a LIMS system ? Yes  No 
   How many users will access the application
   at the same time?
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   Do you have a document describing the
   Functional requirement of the system?
   if yes, please attach.
   What is your active or expected budget range?
* Approximate date of purchase
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