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Work Request
In emergencies please contact us at sales@adhochealthcare.com
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* Indicates required question
Name
*
Your answer
Email address
*
Your answer
Name of Company
*
Your answer
Country of Incorporation
*
Your answer
Contact Number
*
Your answer
Business Industry Type
*
Pharmaceuticals
Wellness Products
Retail Store
Clinic
Health Tech
Medical Devices
Cosmetics
Distribution and Logistics
Exports
Homecare Services
Health Foods
Other:
Do you have an existing website ?
*
Yes
No
Please share link to the website
Your answer
Total Number of Products to be listed in the website
*
Less than 10
10-24 Products
25-50 Products
More than 50
Preferred platform to build website
Shopify
Woocommerce
Magento
Need a new customized website
Not sure
Clear selection
Due date for completing the website
MM
/
DD
/
YYYY
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