Visitor Questionnaire

I'm gathering information about visitors to my site. I'm gathering this information solely for the purpose of being able to better serve and respond to the needs and desires of my site's visitors. Information you provide to me here will not be given or sold to spammers, nor will you receive any unsolicited e-mail from me. Thank you for your cooperation and participation.

First Name:      Last Name:
City:      State:
Zip Code:      Country:
URL:
What is your age group?
Under 13 13 to 19 20 to 34
35 to 49 50 to 64 Over 65
What is your field? (Multiple items may be selected.)
Finance Manufacturing Agriculture Government
Sales Health Care Retail Construction Technology
Real Estate Entertainment Education Other
How did you find out about this site? (Hold down Ctrl or Shift key to make multiple selections.)
Comments:
  

Alicia Hightower
E-Mail: alicia_h@bigcorp.com
Home Page: http://www.bigcorp.com/