Request Form - Data Collection Point

If you are interested in a data collection point on your own server, please fill in the form below! A data collection point is necessary to conduct online surveys with GrafStat.

Given Name: *

Surname: *

Company/Institution:*

E-Mail: *

Department/Sector*

Production	Trade
Bank/Insurance	Handicraft
Education	Public Administration
Consulting	Market Research
Social Service	General Services
Other:

Position: *

Clerk	CEO	Administration
IT-Assistant	IT-Administration	Other:

The marked * fields are necessary!