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First Name

Last Name

Company Name

Address Line 1:

Address Line 2:

City:

State:

Zip Code:

Company URL

Phone

Fax

Are You

Male Female

Year of Birth

Highest Level
Education Completed:

Job Industry

What is your primary job function?

How do you seek new customers? Check all that apply.

	Business Web Site		Newspapers
	Direct Mail		Print Materials (brochures, post cards)
	eMarketing		Radio
	Events & Seminars		Referrals (Word of Mouth)
	Telemarketing		Outside Sales Force
	Other:

What medium do you use to communicate with your customers? Check all that apply.

	Business Events		Magazines
	Direct Mail		Newspaper
	Email		Outdoor
	Other:

How many employees?

How many offices sites and/or retail locations do you have?

What hardware platform are you using? Check all that apply.

Macintosh
PC

Other:

Which Operating System do you use? Check all that apply.

Linux
MacOS
Unix
Windows 2000
Windows 95

Windows 98
Windows ME
Windows NT 4
Windows XP

Other:

What business software and web based services are you currently using? Check all that apply

Office Productivity
Accounting/Billing
Shipping/Fulfillment
Data Storage/Backup
Video Conferencing

Contact Management
Sales Force Management
Project Management
Payroll Services
Remote PC Access

Other:

How many PC work stations do you have?

What kind of Internet access do you have?

Dial-up Modem (56K)
Cable Modem/DSL (aDSL)
Business Class DSL (sDSL)
DSL via Satellite TV(like Direct TV or Dish Network)
T1 or higher

What's your annual IT budget?

How will you spend your IT budget ? Check all that apply.

Hardware
Software
Networking/Virtual Private Networks
eBusiness/Web Development
Enterprise Solutions
Video Conferencing

Consulting/IT Strategy Development
Point-of-Sale Solutions
Security/Data Mining
Certifications/Employee Training
Human Resource Management

Other:

What's on you Technology "wish list" for the next year? Check all that apply.

Hardware
Software
Networking
eBusiness/Web Development
Enterprise Solutions
Video Conferencing

Consulting/IT Strategy Development
Point-of-Sale Solutions
Security/Data Mining
Certifications/Employee Training
Human Resource Management
Virtual Private Networks

Other:

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