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  • Referral Lead

    This form is used for new business EPX Referrals. All fields are required. Your referral will be forwarded to an EPX Manager for review. Thanks so much for your participation in the Epicor EPX Referral Program.

    Referral Information:

    Referring Party Name: 

    Epicor Phone Number: 

    Epicor E-mail Address: 


    Referred Company Information:

    Referred Company Name: 

    Contact Name (Lead): 

    Title: 

    Address: 

    City:  State/Province: 

    Zip/Postal Code:  Country: 

    Phone Number: 

    E-mail Address: 

    Please describe your relationship to the lead:

       

    Number of locations: 

      Please check the box if the contact is aware that you are providing this referral


     

     

     

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