E-fax Communications, Inc. 1611 Telegraph Ave. Ste 555 Oakland, CA 94612 510-836-6000 510.836.8935 Fax PACIFIC BELL FAX SERVICES LEAD GENERATION FORM FAX TO 510.836.8935 PACIFIC BELL SALES REPRESENTATIVE ___________________________________________________________________________________ NAME:........................................... PHONE:................................. FAX:................................ ___________________________________________________________________________________ LEAD ---- NAME:................................................................. TITLE:................................................................ COMPANY:.............................................................. ADDRESS:.............................................................. CITY:..................................................................... STATE:.............................. ZIP:.............................. PHONE:................................................. FAX:................................................. ___________________________________________________________________________________ SERVICES NEEDED --------------- FAX BROADCAST____ FAX MAIL____ FAX-ON-REQUEST____ ___________________________________________________________________________________ SPECIAL INSTRUCTIONS -------------------- ___________________________________________________________________________________ E-FAX FOLLOW-UP --------------- SENT INFO PKG____ CALLED LEAD_____ LEAD SIGNED_____ LEAD DID NOT SIGN____ ___________________________________________________________________________________