Contact Name for your account*

Your Name (if different than contact)*

Title*

Email Address*

Existing Company Website

Existing Site Hosted By:

Company Name*

Address 1*

Address 2

City*

State*

Zip*

Area Code & Phone*

Ext:

Area Code & Fax*

How do you normally order your direct mail, advertising, or graphics?
I do it myself
Someone else at my company orders it
Our creative services agency orders it for us
Other

Have you ever used direct mail before?
Many times
A few times
Once
Never

Does your company have more than one location or office?
Yes
No

What type(s) of computers do you use?
PC/Windows
Macintosh
Both

What type(s) of portable storage do you use?
Floppy disks
Zip 100/250 disks
CD-R or CD-RW

Do you have a connection to the Internet?
My office computer is connected to the Internet
My computer is not connected, but others at our office are
We do not have Internet access at our office

What speed Internet connection do you have?
28.8K/33.6K or slower dialup
56K dialup or ISDN
DSL or Cablemodem
T1 or faster
Don't know, but it is pretty fast
Don't know, but it is pretty slow

What types of advertising does your company use?
Please check all that apply.
Television
Newspaper
Radio
Magazines
Direct Mail
Internet/Email
Do not do advertising now
Other:

How much do you spend on advertising in a year?* $ 

Grip contacted me by phone
Grip contacted me by email
Direct mail
Trade show
Seminar
I'm already a Grip customer
Referred by friend/colleague:
Searching on the Internet
Press coverage
Personal contact
Consultant
Other