"Want us to do a survey for your company?"

This form is for the use of customers and potential customers to provide an estimate of the costs involved in using our survey services.  

The purpose of this questionnaire is to gather  information in order to provide the most accurate price quote in the shortest amount of time possible.

Thank you in advance for considering The MBS Internet Research Center for your upcoming survey project.

1. How many questions do you intend to ask in your survey?

2. How would you prefer your survey to be administered?

The Web
Via Plain Text E-mail
Both 
Other, please specify

3. Who is the target audience? (Employee Satisfaction, Customer Satisfaction, etc.)

MBS Targeted Demographic
Employees
Customers
Other, please specify:

4.  How many completed responses do you expect to receive?

5. Do you plan to offer respondents an incentive to take the survey?

Yes [Go to question 6]
No [Go to question 7]

6. What type of incentive do you plan to offer?

7. What is your time frame for this project? (From beginning of project through delivery of final results.)

Estimated Project Schedule/Deadline (dates or # of weeks)

8. What are your final report requirements?

Standard Frequency (Counts & percents for each question)
Detailed Analysis (Including Crosstabs and/or a Summary)
Database of Results Only (No Report)

9. Do you need help writing your survey?

Yes

No

10. What is your approximate project budget?

$

Please fill out the contact information below so we may contact you with any additional questions and/or the project quotation.

 

First Name:	(*required)
Last Name:	(*required)
Title:
Company:	(*required)
E-mail Address:	(*required)
Phone #:	(*required)
Mailing Address:
Suite #/PO Box:
City:
State:	Alabama Alaska Alberta American Samoa Arizona Arkansas British Columbia California Canal Zone Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northern Mariana Is Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Trust Territories Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Other
Country:
Zip Code:

Is there any addition information you would like to provide? 

Select "Send Info"  now to send your information to us. We will be contacting you shortly.  Thanks for considering the MBS Internet Research Center.