First Name

Last Name

Title

Company

Address

Address 2

City

State

Postal Code

Phone

Fax

e-mail

Size of company (please select a range from the pull down menu)

1-10 employees 10-20 employees 20-40 employees 50-100 employees 100+ employees

1. Do you or any of your employees work from home?
   yes  no
   Do you want to? yes  no
   
   
   
2. Does your company have more than one location?
   yes  no
   How many?
   Are they connected? yes  no
   
   
   
3. Do you have a formal IT strategy designed or do you just do projects as the need arises?
   formal IT strategy
   just do projects as the need arises
   Is that acceptable to you? yes  no
   
   
   
4. Are you responsible for IT support decisions in your company?
   yes  no
   
   
   
5. Do you have special line of business applications specific to your company or industry?
   

yes	Name of LOB application
no




6. Do you have a current network service provider?
   yes  no
   More than one? yes  no
   
   
   
7. Are all the services you need available from your standard vendors? yes  no
   
   
   
8. Have past IT projects at your company been properly managed or have the projects left something to be desired?
   properly managed something to be desired
   
   
   
9. What is your biggest frustration related to technology?
   

Would you like an i-systems rep to contact you to further discuss your IT plans? yes  no

Would you like to receive our "Virus alert bulletins"?
yes  no

Thank you! Your free "golf bag style cooler" will be on it's way to you!

Note: the information you have provided will not be shared with anyone outside of our company.