Qualitative Bid Request Form

Please complete the form to submit a bid request on qualitative work:

Contact Information:

First Name

Last Name

Title

Organization

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Work Phone

FAX

E-mail

URL

Study Specifications:

Date(s) of Project:

Group 1:			# of Recruits
Group 2:			# of Recruits
Group 3:			# of Recruits
Group 4:			# of Recruits

Audio/Video Requirements

Audio:		Video Operator:
Yes No		Yes No
Stationary Video:		Video Format:
Yes No		VHS DVD

Other

Note Takers:

Yes
No

Study Specifics:

Special Instructions/Requests:

Respond to Me Via:

Fax     E-Mail  Phone

First Name
Last Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail
URL

Qualitative Bid Request Form

Copyright © 2007 Product Acceptance & Research. All rights reserved. Revised: December 18, 2008

Copyright © 2007 Product Acceptance & Research. All rights reserved.
Revised: December 18, 2008