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<title>Free Gift</title>
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<tr>
<td colspan="2" bgcolor="#FFFFFF" style="padding-left: 15px;">
<form action="/cgi-bin/formmail.pl" method="post">
<input type="hidden" name="recipient" value="[email protected]">
<input type="hidden" name="subject" value="Sionadd Questionnaire Response">
<input type="hidden" name="redirect" value="http://www.genisign.com">
<p class="style2">Complete Survey: </p>
<table style="font-weight: bold;">
<tr>
<td>Name:</td><td><input type="text" name="realname"></td>
</tr>
<tr>
<td>Address:</td><td><input type="text" name="address"></td>
</tr>
<tr>
<td>City:</td><td><input type="text" name="city"></td>
</tr>
<tr>
<td>State:</td><td><input type="text" name="state"></td>
</tr>
<tr>
<td>Zip:</td><td><input type="text" name="zip"></td>
</tr>
<tr>
<td>Email:</td><td><input type="text" name="email"></td>
</tr>
<tr>
<td>Phone:</td><td><input type="text" name="phone"></td>
</tr>
</table>
<table>
<tr>
<td valign="top"><strong>Did you gather what the product does?</strong></td>
<td> <p>
<select name="best_time_to_call">
<option value="Excellent">Excellent</option>
<option value="Good">Good</option>
<option value="Average">Average</option>
<option value="Poor">Poor</option>
<option value="Very Poor">Very Poor</option>
</select>
<br>
<br>
Comments?
<input type="text" name="number_of_windows2">
</p>
</td>
<tr>
<td valign="top" bgcolor="eeeeee"><strong>Is the technology original?</strong></td>
<td bgcolor="eeeeee"><p>
<select name="select">
<option value="Excellent">Excellent</option>
<option value="Good">Good</option>
<option value="Average">Average</option>
<option value="Poor">Poor</option>
<option value="Very Poor">Very Poor</option>
</select>
<br>
<br>
Comments?
<input type="text" name="number_of_windows3">
</p>
</td>
</tr>
<tr>
<td valign="top"><strong>Is the product innovative?</strong></td>
<td><p>
<select name="select2">
<option value="Excellent">Excellent</option>
<option value="Good">Good</option>
<option value="Average">Average</option>
<option value="Poor">Poor</option>
<option value="Very Poor">Very Poor</option>
</select>
</p>
<p>Comments?
<input type="text" name="number_of_windows4">
</p>
</td>
</tr>
<tr>
<td valign="top" bgcolor="eeeeee"><strong>Do you believe it can provide a service?</strong></td>
<td bgcolor="eeeeee"><p>
<select name="select3">
<option value="Excellent">Excellent</option>
<option value="Good">Good</option>
<option value="Average">Average</option>
<option value="Poor">Poor</option>
<option value="Very Poor">Very Poor</option>
</select>
</p>
<p>Comments?
<input type="text" name="number_of_windows42">
</p>
</td>
</tr>
<tr>
<td valign="top"><strong>What are the most distinctive attributes that differentiate us from other offerings</strong></td>
<td><p>
<select name="select4">
<option value="Excellent">Excellent</option>
<option value="Good">Good</option>
<option value="Average">Average</option>
<option value="Poor">Poor</option>
<option value="Very Poor">Very Poor</option>
</select>
</p>
<p>Comments?
<input type="text" name="number_of_windows43">
</p>
</td>
</tr>
<tr>
<td valign="top" bgcolor="eeeeee"><strong>What did you like most about the product?</strong></td>
<td bgcolor="eeeeee"><p>
<select name="select5">
<option value="Excellent">Excellent</option>
<option value="Good">Good</option>
<option value="Average">Average</option>
<option value="Poor">Poor</option>
<option value="Very Poor">Very Poor</option>
</select>
</p>
<p>Comments?
<input type="text" name="number_of_windows44">
</p>
</td>
</tr>
<tr>
<td valign="top"><strong>What did you like least about the product?</strong></td>
<td><p>
<select name="select6">
<option value="Excellent">Excellent</option>
<option value="Good">Good</option>
<option value="Average">Average</option>
<option value="Poor">Poor</option>
<option value="Very Poor">Very Poor</option>
</select>
</p>
<p>Comments?
<input type="text" name="number_of_windows45">
</p>
</td>
</tr>
<tr bgcolor="eeeeee">
<td valign="top"><strong>Has an variable output of 60 volts and 5 amps giving 200 watts?</strong></td>
<td><p>
<select name="select10">
<option value="Excellent">Excellent</option>
<option value="Good">Good</option>
<option value="Average">Average</option>
<option value="Poor">Poor</option>
<option value="Very Poor">Very Poor</option>
</select>
</p>
<p>Comments?
<input type="text" name="number_of_windows452">
</p></td>
</tr>
<tr>
<td valign="top"><strong>Ability to vary voltage over the full range?</strong></td>
<td><p>
<select name="select11">
<option value="Excellent">Excellent</option>
<option value="Good">Good</option>
<option value="Average">Average</option>
<option value="Poor">Poor</option>
<option value="Very Poor">Very Poor</option>
</select>
</p>
<p>Comments?
<input type="text" name="number_of_windows453">
</p></td>
</tr>
<tr bgcolor="eeeeee">
<td valign="top"><strong>The ability to provide current limiting?</strong></td>
<td><p>
<select name="select12">
<option value="Excellent">Excellent</option>
<option value="Good">Good</option>
<option value="Average">Average</option>
<option value="Poor">Poor</option>
<option value="Very Poor">Very Poor</option>
</select>
</p>
<p>Comments?
<input type="text" name="number_of_windows454">
</p></td>
<tr>
<td valign="top"><strong>The ability to vary the voltage over the full range</strong><strong>?</strong></td>
<td><p>
<select name="select13">
<option value="Excellent">Excellent</option>
<option value="Good">Good</option>
<option value="Average">Average</option>
<option value="Poor">Poor</option>
<option value="Very Poor">Very Poor</option>
</select>
</p>
<p>Comments?
<input type="text" name="number_of_windows455">
</p></td>
</tr>
<tr bgcolor="eeeeee">
<td valign="top"><strong>The fact that the device is 95-98% efficient?</strong></td>
<td><p>
<select name="select14">
<option value="Excellent">Excellent</option>
<option value="Good">Good</option>
<option value="Average">Average</option>
<option value="Poor">Poor</option>
<option value="Very Poor">Very Poor</option>
</select>
</p>
<p>Comments?
<input type="text" name="number_of_windows456">
</p></td>
</tr>
<tr>
<td valign="top"><strong>Reduced noise held less than 10 mv?</strong></td>
<td><p>
<select name="select15">
<option value="Excellent">Excellent</option>
<option value="Good">Good</option>
<option value="Average">Average</option>
<option value="Poor">Poor</option>
<option value="Very Poor">Very Poor</option>
</select>
</p>
<p>Comments?
<input type="text" name="number_of_windows457">
</p></td>
</tr>
<tr bgcolor="eeeeee">
<td valign="top"><strong>Can sit in the palm of your hand?</strong></td>
<td><p>
<select name="select16">
<option value="Excellent">Excellent</option>
<option value="Good">Good</option>
<option value="Average">Average</option>
<option value="Poor">Poor</option>
<option value="Very Poor">Very Poor</option>
</select>
</p>
<p>Comments?
<input type="text" name="number_of_windows458">
</p></td>
</tr>
<tr>
<td valign="top"><strong>The ability to program it?</strong></td>
<td><p>
<select name="select17">
<option value="Excellent">Excellent</option>
<option value="Good">Good</option>
<option value="Average">Average</option>
<option value="Poor">Poor</option>
<option value="Very Poor">Very Poor</option>
</select>
</p>
<p>Comments?
<input type="text" name="number_of_windows459">
</p></td>
</tr>
<tr bgcolor="eeeeee">
<td valign="top"><strong>Weighs less than a pound?</strong></td>
<td><p>
<select name="select18">
<option value="Excellent">Excellent</option>
<option value="Good">Good</option>
<option value="Average">Average</option>
<option value="Poor">Poor</option>
<option value="Very Poor">Very Poor</option>
</select>
</p>
<p>Comments?
<input type="text" name="number_of_windows4510">
</p></td>
</tr>
<tr>
<td valign="top"><strong>The device can be stacked campus wide?</strong></td>
<td><p>
<select name="select7">
<option value="Excellent">Excellent</option>
<option value="Good">Good</option>
<option value="Average">Average</option>
<option value="Poor">Poor</option>
<option value="Very Poor">Very Poor</option>
</select>
</p>
<p>Comments?
<input type="text" name="number_of_windows4511">
</p></td>
</tr>
<tr bgcolor="eeeeee">
<td valign="top"><strong>The devices can be synchronized globally?</strong></td>
<td><p>
<select name="select8">
<option value="Excellent">Excellent</option>
<option value="Good">Good</option>
<option value="Average">Average</option>
<option value="Poor">Poor</option>
<option value="Very Poor">Very Poor</option>
</select>
</p>
<p>Comments?
<input type="text" name="number_of_windows4512">
</p></td>
</tr>
<tr>
<td valign="top"><strong>Single output?</strong></td>
<td><p>
<select name="select9">
<option value="Excellent">Excellent</option>
<option value="Good">Good</option>
<option value="Average">Average</option>
<option value="Poor">Poor</option>
<option value="Very Poor">Very Poor</option>
</select>
</p>
<p>Comments?
<input type="text" name="number_of_windows4513">
</p></td>
</tr>
<tr bgcolor="eeeeee">
<td valign="top"><strong>Provides real-time graphics?</strong></td>
<td><p>
<select name="select19">
<option value="Excellent">Excellent</option>
<option value="Good">Good</option>
<option value="Average">Average</option>
<option value="Poor">Poor</option>
<option value="Very Poor">Very Poor</option>
</select>
</p>
<p>Comments?
<input type="text" name="number_of_windows4514">
</p></td>
<tr>
<td valign="top"><strong>Can communicate across the network: Ethernet, RS232?</strong></td>
<td><p>
<select name="select20">
<option value="Excellent">Excellent</option>
<option value="Good">Good</option>
<option value="Average">Average</option>
<option value="Poor">Poor</option>
<option value="Very Poor">Very Poor</option>
</select>
</p>
<p>Comments?
<input type="text" name="number_of_windows4515">
</p></td>
</tr>
<tr bgcolor="eeeeee">
<td valign="top"><strong>Meets regulatory requirements: Time stamps, passwords and audit trails?</strong></td>
<td><p>
<select name="select21">
<option value="Excellent">Excellent</option>
<option value="Good">Good</option>
<option value="Average">Average</option>
<option value="Poor">Poor</option>
<option value="Very Poor">Very Poor</option>
</select>
</p>
<p>Comments?
<input type="text" name="number_of_windows4516">
</p></td>
</tr>
<tr>
<td valign="top"><strong>Is the 128 bit encryption necessary for security?</strong></td>
<td><p>
<select name="select22">
<option value="Excellent">Excellent</option>
<option value="Good">Good</option>
<option value="Average">Average</option>
<option value="Poor">Poor</option>
<option value="Very Poor">Very Poor</option>
</select>
</p>
<p>Comments?
<input type="text" name="number_of_windows4517">
</p></td>
</tr>
<tr bgcolor="eeeeee">
<td valign="top"><strong>Comes with windows 95, vista compliant software?</strong></td>
<td><p>
<select name="select24">
<option value="Excellent">Excellent</option>
<option value="Good">Good</option>
<option value="Average">Average</option>
<option value="Poor">Poor</option>
<option value="Very Poor">Very Poor</option>
</select>
</p>
<p>Comments?
<input type="text" name="number_of_windows4519">
</p></td>
</tr>
<tr>
<td valign="top"><strong>Can implement enterprise wide central security and control?</strong></td>
<td><p>
<select name="select23">
<option value="Excellent">Excellent</option>
<option value="Good">Good</option>
<option value="Average">Average</option>
<option value="Poor">Poor</option>
<option value="Very Poor">Very Poor</option>
</select>
</p>
<p>Comments?
<input type="text" name="number_of_windows4518">
</p></td>
</tr>
<tr bgcolor="eeeeee">
<td valign="top"><strong>What would you price it at?</strong></td>
<td><input type="text" name="number_of_windows45"></td>
</tr>
<tr>
<td valign="top"><strong>Would you like more information on the product?</strong></td>
<td><input type="text" name="number_of_windows46"></td>
</tr>
<tr bgcolor="eeeeee">
<td valign="top"><strong>What is the likelihood that you would purchase the device?</strong></td>
<td><input type="text" name="number_of_windows47"></td>
</tr>
</table>
<div align="center" style="padding: 8px;">
<input type="reset" value="Reset"> <input type="submit" value="Submit">
</div>
</form>
</td>
<td width="156" valign="top" bgcolor="#eeeeee"> </td>
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