Consumer Centers Request an Estimate

REQUEST AN ESTIMATE

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.

	Request an Estimate \| Participate \| Contact Us

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)