Fill and Sign the Business to Business Market Survey Form

Business-to-Business Market Survey 1. In what type of business, industry or profession do you work? (Please check one.)  Agriculture/forestry/construction  Data processing/computers  Finance/banking/insurance  Health care (medical, dental, etc.)  Real estate  Wholesale trade  Retail trade  Other: ______________ (please specify)  Communications/publishing/advertis-ing  Education  Government/public administration  Manufacturing  Personal/business services (consultant, CPA, lawyer, etc.)  Transportation/public utilities 2. What is your position? (Please check only one.)  Chairman of the Board  Owner/Partner  Other Company Officer (V.P., Treasurer, etc.)  Manager  Scientist or Engineer  Sales  Clerical  Other: _______________ (please specify)  President/CEO  Director  Department Head  Supervisor/Foreman  Other administrative position not mentioned  Technical Specialist  Retired 3 . How many people, including yourself, work at your company, including branches, international offices and plants? (Please check only one.)  Under 10  25 - 49  75 - 99  250 - 499  1,000 - 4,999  10,000 or more  10 - 24  50 - 74  100 - 249  500 - 999  5,000 - 9,999 4a. What are your company’s annual gross sales or revenues? (Include all plants, branches, divisions and subsidiaries.)  Less than $250,000  $500,000 - $999,999  $5 million - $9.9 million  $25 million - $99.9 million  $250,000 - $499,999  $1 million - 4.9 million  $10 million - $24.9 million  $100 million or over 4b. What year did your business start? _______________ 5. Do you serve on your company's board of directors?  Yes  No 6. Are you on the board of directors of any other company?  Yes  No 7a. Are you an owner or a partner of a business?  Yes  No 7b. If you answered yes, in what industry or profession were you employed and what was your job title before you became an owner or partner? Industry or Profession: _______________________ Job Title:________________________ 7c. Are you considering starting or buying a new or additional business?  Yes  No 7d. If you are planning to start or buy a new business, when do you plan to do so?  In the next six months  In 13 to 24 months  Not sure  In 7 to 12 months  More than 24 months from now 8. In the last 12 months, have you been directly involved in initiating, recommending, ordering or approving the purchase of any of the following products or services for your firm? (Please check all that apply.)  Accounting services  Answering/paging systems  Building materials/equipment  Computers and computer accessories and/or related computer equipment (include time-sharing)  Credit cards  Fax machines  Insurance  Office supplies (including office paper)  Real estate and/or office or plant location  Telecommunications equipment/services  Travel services  Advertising /PR/sales promotion  Banking and financial services  Car/truck/van purchase or lease  Computer software  Copiers  Express mail/courier/package delivery, overnight delivery  Office furniture and fixtures  Other office machines (calculators, typewriters, postage meters, etc.)  Temporary office help/employee recruitment  None of these 9. Which express mail/package delivery services do you use? (Please check all that apply.)  Federal Express  United Parcel Service  Emery/Purolator  U.S. Postal Service/Express Mail  DHL  Other: ______________ (please specify)