Performance Plus -Bid Form

PERFORMANCE PLUS BID FORM

* indicates required fields

Check all that apply:

Focus Groups / IDI's Online Survey's Facility Only

Field Telephone Survey's Mall Intercept's Usability Medical

Date:

Time:

*First Name:

*Last Name:

*Company:

*Address:

*City:

*State:

*Zip Code:

*Phone:

Fax:

*Email:

Billing Info *(if different from above)*
First Name:		Last Name:
Company:
Address:
City:	State:		Zip Code:
Phone:	Fax:
Email:

Referred By:

Focus Group Locations:

Framingham

Boston

Providence Connecticut

Mall Intercept Locations:

Boston Medford Brockton Providence Connecticut

Groups

IDI's

Project Date:	Time:	Co-op:	Time:	Co-op:
Project Date:	Time:	Co-op:	Time:	Co-op:
Project Date:	Time:	Co-op:	Time:	Co-op:

Total Number of:

Groups:

Length:

Hrs.

IDI's:

Length:

Hrs.

Recruit

for

to show.

Recruit From:

Database

Client List

	Yes	No
Stationary Video:
Audio Taping:
Video with Operator:
Video Conference:
Video Streaming:

Specification and Quotas:

Subject Of Research Box:

Type Of Respondent:

Age Quotas:

Income Quotas:

Past Participation:

6 months

12+ months

Never

Male/Female Quotas:

Additional comments for special equipment or project specifications:

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