Assessment Technology

Required fields in bold

What activity is your business most
involved in?:

Providing professional business services

Manufacturing products

Wholesaling goods or
supplying parts

Providing legal services

Offering financial services

Broadcasting or telecommunications

Retailing goods to consumers

How many employees do you have?:

0-10
11-100
101-749
750+

Does your business or organization have a web site?:

Yes
No

Do you use your web site to directly generate business income for your products or services?:

Yes
No

Do you use your web site to collect information
from clients?:

Yes
No

Do you store critical business data electronically:

Yes
No

Do you store confidential information of others electronically?:

Yes
No

Do you perform background checks on new employees, vendors and/or consultants who do work for you?:

Yes
No

Full Name:

Company Name:

E-mail Address:

Street Address:

City:

State:

Zip:

Phone Number:

Fax Number:

Comments: