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TodayÆs Date:

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Name:
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Company:
Parent Company:
Email:
Business Phone:
Business Fax:

Mailing Address

Address 1:
Address 2:
City:
State:
Zip Code:
Is the above your home address?Yes No
If yes, please type your business address below.
Address:
Address 2:
City:
State:
Zip Code:


1. Primary Job Function (select one)

Other (please specify):


2. Primary Business Activity (select one)

VAR,Integrator, Consultancy

 
Communications: Data/Telcom, Cable, Wireless
Utilities: Gas, Electric, Water, Sanitation
School, University, Library, Archive, Museum, Foundation, Church, Social Services Agency
Wholesale/Retail (non-computer)
Business/Accounting Svcs.
Design, Graphic Arts, Pre-Press, Printing Services
Transportation: Land, Sea, Air
Medical, Healthcare, Hospitals, HMO's, Clinics, Labs
Legal Services
Information Svcs., Media, Publishing, Adv, Radio/TV, Online/Internet
Computer/DP Svcs., Software
Engineering, Science, R&D
Mining, Constr., Petroleum, Refining, Agriculture
Distr., Dealer, Service Bureau

Manufacturing
Computers, Communications, Electronics Equipment
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Automotive
Other Discrete Manufacturing
Pharmaceutical, Chemical
Other Process Manufacturing

Finance
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Securities, Credit, Brokerage, Trading
Real Estate

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Federal, Military
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Courts

Other (please specify):


3. For approximately how many seats do you buy, specify, recommend or approve purchases of computing and/or networking hardware, software and peripherals for imaging, document management, workflow/groupware? (select one)


4. What is the total number of sites for which you have purchase influence? (select one)


5. What is the highest level for which you have purchase influence? (select one)


6. On an annual basis how much do you anticipate your organization will spend on hardware, software, peripherals and services for document imaging, document management, workflow or groupware at your location? (select one)


7. People employed by your organization (check only one in each category)

At your site?

In the entire enterprise


8. Please indicate the computing and network operating systems in use at this entire location: (select all that apply)

To select multiple answers, hold down the Control key while choosing.
Client OS

Other

Server OS

Other

Host OS

Other

None of the above


9. Do you purchase or influence the purchase of: (select only one in each category)

YES NO
Applications development tools/products
Network, Inter/Intra-network products

None of the above


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