PI Data Cleanup Service Request

Please provide the following details to request the professional service: PI Data Cleanup Service.

After submitting this form, within 1 business day Believable Magic will deliver via email an Independent Contractor Agreement for this service to be signed electronically.

Primary Contact Name *

First

Last

This person will receive communications and manage the delivery of this particular service. This person might be different from the person who signs the agreement shown later in this form.

Primary Contact Email *

Company Legal Name *

The legal name of the company that will appear on the Independent Contractor Agreement (e.g. "ABC Widgets, Inc.")

Predictive Index Customer Confirmation *

• The organization described above is a current customer of The Predictive Index

Company Incorporating Jurisdiction *

The state, province, country or other governing jurisdiction under which the organization is formed, registered or recognized (e.g. "Texas, USA" or "Denmark")

Company Location Address *

The physical mailing address describing the organization's primary location of business for the purpose of the agreement.

Company Employee Headcount *

The headcount number used to set your contract size with The Predictive Index -- this reflects the size of the organization using PI.

Agreement Signer Name *

The complete name of the person who will sign the agreement electronically.

Agreement Signer Position Title *

The position title of the person signing the agreement (e.g. "Vice President", or "Managing Member")

Agreement Signer Email *

The email address to which the agreement should be delivered for an electronic signature (may be the same as or different from the Primary Contact Email)

Comment or Message

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