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^*Name:		Address:
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^*Company Name:		^*City:
^*Telephone:		^*State/Province:
^*E-mail Address:		Zip/Postal Code:
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To help us serve you better, please provide the following information:
1. In what industry is your company listed:
2. Number of Temporary employees you require monthly:
3. Type of skillsets you would like us to provide:
4. Do you need the capability of consolidated reporting? Yes No
5. Do you have needs at other locations? Yes, regional Yes, national No
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