Disc Information Services

CONTACT INFORMATION

*Company

*Contact Person

*E-mail

*Confirm E-mail

Mail Address

City  State  Zip

Street Address

City  State  Zip

Phone

Fax

Desired survey notification format (how we contact your customers)
Selection explanation:

1. Email only if you have the email addresses of (most) all of your customers
2. Mail only if you do not have many of your customers email addresses and favor a postcard notification be sent to your customers asking them to go to the online survey
3. Email + Mail if you have the email addresses of many but not all of your customers and need to contact them by both email and postcard

Email only survey with data analysis report

       Email survey notification (included)

Email + postcard notification (option)

Mail only survey with analysis report

       Mail + postcard notification

Email + Mail survey with analysis report

       Email + postcard notification

Estimated number of customers-responders to survey

Check here if you do NOT want us to send a reminder (standard survey procedure) to your non responders after seven to ten business days from survey launch date.

*Required Fields