Assessment Request Form

Bill To

Company*

Contact Person

Contact Phone Number

Billing Address

*Only complete if this is your first time requesting an assessment through Revela.

Street Address City State ZIP Code

Candidate Name*

First Last

Candidate Email Address*

What date would you like the assessment to be sent?

*If no date is entered, assessment will be sent the day the form is submitted.

Which assessment would you like to send?*

Profile XT (multi-purpose assessment used for hiring and coaching)
PXT Select (one person, one position)
Profiles Sales Assessment (a version of the PXT used specifically for sales positions)
Everything DiSC® (information about a person's communication style)

Which reports would you like to receive?*

Which reports would you like to receive?*

Which Profiles Performance Model would you like these reports to be run against?*

Which version of the assessment would you like?*

Who should receive the results?*

Other Information

Please enter any other information we should know. (Example: Allocate to Branch #123 on the invoice.)