AI Agent Access Request Form - Opal Tech Services

Full Name

Enter your full name as it appears.

This field is required.

Business Name

Enter the name of your business.

This field is required.

Position/Role

Enter your position or role in the business.

This field is required.

Phone Number

Enter your phone number including the country code.

This field is required.

Email Address

Enter a valid email address for communication.

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Business Website

Enter your business website URL if applicable.

This field is required.

AI Agent Service Request

Select the AI Agent(s) you’re interested in.

Customer Support AI Agent

Sales & Lead Generation AI Agent

Marketing Automation AI Agent

Workflow/Task Automation Agent

Data Analytics & Business Intelligence Agent

Virtual Business Assistant

AI Content Creation & Management Agent

Employee AI Training & Consultation

Other

This field is required.

Purpose of Request

What do you want the AI Agent to help your business achieve?

Improve customer support

Generate more sales/leads

Save time with automation

Improve data-driven decisions

Boost marketing reach

Other

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Access & Setup Preference

Do you need a Demo Access first or Full Deployment?

Demo Access

Full Deployment

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Team Members Count

How many team members will use this AI Agent?

1–5

6–20

21–50

50+

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Preferred Integration

Preferred Integration Method

Website

Social Media Pages

CRM / ERP System

Other

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Estimated Budget

Select your estimated budget for the project.

$100 – $499

$500 – $999

$1K – $10K

Above $10K

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Expected Deployment Timeline

Select your expected deployment timeline.

2–4 Weeks

1–3 Months

Flexible

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Additional Notes

Please describe any specific requirements, features, or integrations you want in your AI Agent.