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The difference is in the details
 


Please take a few minutes to complete this form so that we can best serve your needs. We ask that you kindly fill out all fields so that we can assist you faster and more efficiently.

1. Your Contact Information
First Name:
Last Name:
Company Name:
Address:
City:
State:      Zip Code:
Phone#:      Fax#:
Email:
Contact Person:
Topic:
2. Requested Date(s) of Project
Date(s) of Project:
3. Select Locations:
New York Consumer Center
     28 West 44th St., Suite 500
     New York, NY 10036
     Phone: 212.302.9393
     Toll-Free:
     800.998.GRPS (4777)
     Fax: 212.302.9358
     Email:
     Info@ConsumerCenters.com
Meadowlands Consumer
      Center

     100 Plaza Drive
     Secaucus, NJ 07094
     Phone: 201.865.4900
     Toll-Free: 800.998.GRPS (4777)
     Fax: 201.865.0408
     Email:
     Info@ConsumerCenters.com
Both Locations
4. Study Design (check all that apply):

Please attach your specs below or complete the following:

Focus Groups
Interviews/Mini Groups
    One-on-one
    Diads
    Triads
    In-home
    One-on-one
    Other
   
Mock Trial
Shadow Jury

Ethnography
Product Placements
Facility Rental Only
Kitchen
Fielding Services/Project Mgmt
Professional Interviewer
Moderator
Other

5. Requested Schedule of Qualitative Sessions
  Start Time Length # of Respondents
to Seat/session
Session 1:
Session 2:
Session 3:
Session 4:
6. Additional Study Specifications
7. Technology and Other Requirements (check all that apply)
Audio
Yes   No
   Audio
   Format:
CD   MP3   Cassette 
Other (please specify):
Video
Yes   No
   Video
   Format:
DVD (digital video)   Mini-DVD
1/2 inch Videocassette  PAL
Other (please specify):

Select all that apply from the list below:


If you checked Translator, please specify language(s) in the space below:
8. Special Instructions/Requests
9. How would you like us to contact you?
Email   Phone   Fax

If contact information is different than the information provided above, please specify below:
10. How did you hear about us?

Should you require immediate assistance, please call Meadowlands Consumer Center at (201) 865-4900 or New York Consumer Center at (212) 302-9393 and ask for Bids and Holds. You can also reach us toll free at (800) 998-4777 or email us at Info@ConsumerCenters.com.

Thank you and we look forward to working with you.

Consumer Centers. The Ultimate Qualitative Experience.
       


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Consumer Centers New York Consumer Center, 28 W. 44th Street, New York NY 10036
Meadowlands Consumer Center, 100 Plaza Drive, Secaucus NJ 07094
info@ConsumerCenters.com | 800-998-GRPS (4777)

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