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Welcome to contacting BERN MEDIA. To better serve your needs and get the right information to you, we would like you to take a few minutes and fill out the following questionnaire. Thank you for helping us.
 
Andrew

First, Last Name

Title

Company Name

Address

City / State or Province / Postal or Zip Code

Country

Phone Number

Fax Number

E-Mail Address

 

 

Do you currently have a website?

    Yes No
     

If NO, when are you planning to bring up your website?

    Not Certain Within 30 days
    Within 6 months Greater than 6 months
     

The role of your website will be:

    Intranet (Internal Network Only)
    External (On the internet)
    Both
     

What is your budget for the website?

    $5,000 - $20,000 $20,000 - $50,000
    $50,000 - $100,000 $100,000 or more
 

What is your company size?

    1 - 49 persons 50 - 99 persons
    100 - 249 persons 250 - 500 persons
    over 500 persons
 

How are you involved in the decision making process?

    I am gathering information on how to establish my web presence
    I am determining my need and require consulting and needs analysis
    I am evaluating web service providers
    I am evaluating as in-house solution
    I am ready to begin development (please have someone call me)
     

What type of services are you seeking from BERN MEDIA?

    Full Service Solution Outsourcing Web site management
    Graphics Consulting
    Education and training Hosting
    Other
     

What is your role in the Web project?

    Information gatherer (admin/secretary) Project manager
    Decision maker Developer
     

What is your role in your organization?

    Marketing Public Relations
    Information Services Finance
    Human Resources Other
     

What industry is your business in?  

 
Do you want a sales representative to contact you?

    Yes No
     

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