Employee and Customer Surveys Pricing and Quotation Request

The following is a list of questions that we must ask in order to prepare survey pricing for you. Your answers will give us insight and direction into your expectations so that we may serve you best. Thank you in advance for your time, and for the opportunity to be of service.

When submitting your request, do not use a free email address (Yahoo, Hotmail, etc.) if at all practical. Free email accounts will delay the fulfillment of your request.

All information provided to NBRI will remain strictly confidential. Please review the NBRI Privacy Policy for details.

1.)

What is the purpose of the survey that you are considering? (check all that apply)

	Employee Attitude
	Employee Engagement
	Employee Opinion
	Employee Satisfaction
	Organizational Assessment
	360 Degree Survey
	Employee Exit Interviews
	Customer Satisfaction
	Customer Service
	Customer Loss Reviews
	Guest Service
	Patient Satisfaction
	Physician Satisfaction
	Market Research
	Political Research
	Other
	Please Specify:

2.)

What is the approximate number of individuals to be invited to participate in the survey?

3.)

Please indicate the number of individuals to be invited to participate in each language:

Language

Paper Deployment

On Line Deployment

Telephone Deployment

English

Spanish

French

German

Italian

Other Languages	Paper Deployment	On Line Deployment	Telephone Deployment

4.)

How many survey questions would you like on your survey?

5.)

Your Name:
Your Company Email Address: (Free Email Accounts)

Company Name:
Company Address:
City:
State:
Zip Code:
Your Telephone Number:

And a good time to call you?
Date:
Time:
Time Zone:

6.)

When do you plan to deploy your survey?

	Immediately
	Within 30 Days
	Within 90 Days
	Within 6 Months
	Within 12 Months
	No Plan Right Now. Just Gathering Information.

7.)

Please select the one option that best describes your role in this survey project:

	Information Gatherer
	Recommender
	Project Manager
	Key Decision Maker
	Sole Decision Maker
	Other Role

8.)

Additional Comments:

Additional Information

Would you like to receive free information on any of the following?


	Yes	No

Survey Research Best Practices

Benchmarking

Selecting the Issues to Work On

Action Planning

The Continuous Improvement Process

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