Survey Customization Order Form
This page will allow you to customize the Job Role and Department demographic categories on the employee survey to more closely align with your organizational structure. Please read the following instructions before submitting your request:
(1) The maximum number of category titles per demographic is twenty (20). The maximum number of characters for each category title, including spaces, is thirty (30).
(2) It is important that you select categories that are sufficiently detailed to be meaningful while still broad enough to be likely to collect five completed surveys. We do not report data for any demographic category in which there are fewer than five respondents.
(3) Please enter your category titles carefully. Job Roles and Department demographics will appear on the employee survey exactly as submitted.
(4) Please contact Susan Springer via email at SusanS@BestCompaniesGroup.com with any questions or requests for further customizations.
(5) Please note that all demographic questions including job role and department questions will require a response from employees in order to submit the survey. Please add an ‘Other’ selection if there are any outlying areas that may not be covered in your selections. You may also wish to include a ‘Prefer Not to Answer’ option.
Register Information:
 * Fields are mandatory
Company Name:
* 
Contact First Name:
* 
Contact Last Name:
* 
Contact Title:
* 
Email Address:
* 
Phone Number:
* 
Job Roles:
 
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
 

Use standard survey titles (View job role titles on standard survey)

  Omit this category from the survey
(by checking this box information above will be omitted)
Departments:
 
1
 
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
  Use standard survey titles (View department titles on standard survey)
  Omit this category from the survey
(by checking this box information above will be omitted)
Approval:
  By submitting this form, I understand that my organization will be invoiced for a customization fee of $795.

In order to submit this contact form, please input the verification code
as listed below and select the "submit request" button.
Check the information you have entered, then click Submit