2.	Contact information:
	Country Phone Prefix:	(if country is not U.S. or Canada)
	Phone number (with area code):	*
	Fax number (with area code):	*
	Special number for bids (if any):
	1st contact person:	*
	2nd contact person:
	3rd contact person:
	Email address:
	Website:

3.	Mailing address (if different):
	Address:
	City:
	State/Province:
	Zip/Postal code:
	Country:

4.	Business background:
	Year your business was formed:
	Year facility opened at this location:
	Date of most recent major remodeling:

5.	Conference and viewing rooms:
	Number of conference rooms:	*
	Capacity of the largest focus group room:	*
	Capacity of the largest viewing room:

6a.	Do you have a very large room (with viewing) that can be used for mock juries or audience testing?
	Yes    No

6b.	Do you have a special room for one-on-one interviewing (with viewing)?
	Yes    No

6c.	Is this facility physical or online?
	Physical    Online

7.Services offered - check all that apply. Usability testing 3/4" Videoplayer Free fixed-camera videotaping Closed-circuit tv Full kitchen Client lounge Simultaneous translation Note-taking Perception analyzer Internet access for clients Private client office with computer and telephone Airport pickup service Babysitting Living room style setup Children's furniture Other services:

8. Your location - check all that apply: Central city Suburbs Rural Mall Office building Free-standing building Use Hotel Room Online Facility Other type:

9.	Airport:
	Distance to airport:	(please indicate Miles or Km)

10a. Special audiences you recruit - check all that apply Medical professionals Business executives High-tech Children Teenagers Seniors Other audience:

10b.	Ethnic groups you recruit

10c.	Do you provide in-house recruiting?
	Yes    No

10d.	Do you offer video-conferencing and/or web-conferencing?
	Video-conferencing    Web-conferencing    Both    No

10e.	Name of video-conferencing service
	Name of web-conferencing service

10f.	Do you offer respondent Internet access?
	56K    ISDN/Cable    T1/T3

11.	Nearby hotels (we will only list them if you provide phone numbers)
	1st Hotel Name	Phone
	2nd Hotel Name	Phone

12.	Information about submitter (required)
	Name:	*
	Phone:	*
	Email:	*