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Interact Media Preferences Order Form

 

1) Choose Your Output

 

A) National Report

  1. Included in Level B for Participants
  2. $1,000 for Non-participants

 

B) Data Only Output ($2,500)

  1. Gender
  2. Race
  3. Age
  4. Reason
  5. Demographic
  6. Univariate
  7. National Report included

 

 

 

2) Choose Your Survey Dates

 

1) September

2) October

 

 

3) Do you want Custom Questions?

(must elect #2 or #3 Data Output to be eligible for this section)

1) 2 Custom Questions ($400)
  1. Open Ended or LIKERT

 

2) 4 Custom Questions ($900)
  1. Open Ended or LIKERT

 

3) Additional Questions at $250/per question
  1. Number of Additional Questions (over 4)

 

 

4) Contact Info

 

Name:

 

E-mail:

 

College:    

 

Phone:

 


 

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