Bid Request Form

Please use this convenient way to submit your request for a bid quickly and easily.

---

Your Company Information

Company Name:		Contact Name:		Job Name:
Business Phone:		Fax:		E-mail Address:

STUDY TYPE:	Business to business
	Consumer

---

General Study Description

`

TIME ZONES		SPECIFIC MARKETS		SAMPLE TYPE
National		1.	6.	RDD RDD TARGETED CLIENT LIST
Eastern		2.	7.
Central		3.	8.
Mountain		4.	9.
West		5.	10.

---

If business study Please specify company sizes:		If consumer study Please enter quotas:
SMALL		Percent Male	%
MEDIUM		Percent female	%
LARGE

Type in title/level of respondents		Age breaks
1.		1.
2.		2.
3.		3.
4.		4.
5.		5.

Return data format		Are age breaks within gender
FLAT ASCII			No
CARD IMAGE			Yes
BINARY
EXCEL
OTHER

---

Special Programming Instructions:

---

Additional Notes/Comments/Information:

(Please include field dates)

---

Special Sample Instructions:

(Please include list ratios)

---

Bid	Quota Group	Quota	Net Incidence	Length	Net Incidence	Length	Net Incidence	Length	Sample Type
1.			%	minutes	%	minutes	%	minutes	RDD Targeted RDD Client List
2.			%	minutes	%	minutes	%	minutes	RDD Targeted RDD Client List
3.			%	minutes	%	minutes	%	minutes	RDD Targeted RDD Client List
4.			%	minutes	%	minutes	%	minutes	RDD Targeted RDD Client List
5.			%	minutes	%	minutes	%	minutes	RDD Targeted RDD Client List
6.			%	minutes	%	minutes	%	minutes	RDD Targeted RDD Client List

Please enter the following code in the input box below