SPECIAL REQUISITE SERVICE

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SPECIAL REQUISITE SERVICE REQUEST

Information provided on this form is PII encrypted. PII is a method of protecting personally identifiable information (PII) by making it unreadable to unauthorized users

Name

Email - This is for verification purpose only and to ensure you receive acknowledgement that the request has been received successfully

Company name (This will not be disclosed without your explicit permission)

Solution/Service Request Type

Specification (Please kindly advise full specification with as much details as possible on your requirements and needs. i.e Journey management for 6 months for X number of executive's)

Are there any specific vendor requirements needed for your own internal compliance i.e ISO or other certification criteria

Date of Deployment/Project-Service Start Date

Are there any companies you have already engaged with AND/OR Do not wish to engage with

Would you like this request to stay anonymous in the sourcing stage

Yes

No, it is ok to disclose the name of my organisation

By completing this form I hereby consent to Agora Nexus engaging with relevant suppliers in relation to my request.