Panel Membership Application Form

PANEL MEMBERSHIP APPLICATION FORM

This questionnaire is designed to allow us to identify the main nature of your business and the country in which you operate, to thereby allow us to allocate you to the correct survey panel.

Please provide the following contact information:

Name
Job Title
Company Name
Company Address



Zip / Postal Code
Country
Phone Number
Fax
E-Mail
Name of alternative contact
Phone Number

Please choose the sector which best describes the main nature of your company's business (this is required for allocation to the correct industry sector. Please list the products produced or the nature of the processes undertaken or the services provided by your unit):

Please state the approximate number of people employed by your company:

Please provide an approximation of your company's annual turnover (Please clearly state currency units):