Ordering Products, Services and/or Additional Information

       Ms.  Mr.  Name: 
                  Position: 

                   Company: 
                   Address: 
                            
                      City: 
            State/Province: 
           Postal/Zip Code: 
       Country (if not US): 

                 Telephone: 
                       FAX: 
                     Email: 
               Company URL: 

 Approximate number of employees in your organization: 
                            

 In how many locations do you have offices?
                            

 In how many countries do you have offices?
                            

 In how many countries do you conduct business?
                            

 Type of business/industry: 

 What brought you to our Web site?
 

 Please check any of the following products, services or
 materials for which you would like further information:

        Consulting with management on your website  
           design, development and/or utilization
        Analyzing your present website, identifying
           improvements and enhancements
        Electronic Commerce Solutions
        Training programs
        Secure Server Access
        Local Area Network(LAN), Wide Area Network(WAN), 
	   Virtual Private Network(VPN)
        Training Guides, Booklets and/or Workbooks
        World Wide Co-Host Program
        Working with ICIR as a Development Partner
        Working with ICIR as a Local Representative 
	   in your area
    Other (please specify): 

 Covering what application(s) and/or area(s):

        Internet
        Intranet
        Extranet
        World Wide Web
        Internet Service Provision, Web server,
	   Mail Server, routers etc.
    Other (please specify): 

 Please check any other additional consulting and/or 
 development services for which your organization may 
 have a need or an interest:

        Internet Consulting, Analysis and Programming
        Website creation, makeovers and research, 
	   design, development and organization, 
	   maintenance, copywriting and translation
           services
        Website hosting, relocation, Domain Name 
	   registration and traffic analysis
        Database design, programming and management
        Customized "maintenance databases" that 
	   require no programming skills of the user 
	   so you can at anytime update and maintain 
	   your website right over the Web from 
	   anywhere in the world
        Phase I Website Development & Hosting Package
        Competitor Research and Analysis
        Web, e-mail and secure server solutions, related 
	   network integration and software configuration
        World Wide Web media buying, marketing, public 
	   relations and traditional cross-media promotion
        Email response, organization, management and
 	   distribution strategies
        Audio, Video and Animated Web applications and 
	   CD-ROM programming
        Intra-networking and Inter-networking solutions
        Internet seminars and training programs
        Corporate wide utilization and integration of 
	   Internet technologies
        Telecommunications cost reductions utilizing 
	   Internet video conferencing, voice and fax 
	   capabilities
        Data conversion and storage, content development 
	   for direct download (i.e. full resolution 
	   photos, video or sound for print and other 
	   media distribution)
        Pro-Bono and Community Involvement Work
    Other (please specify): 

 By priority, please list the most important need(s)of
 your organization as they relate to the Internet 
 and/or World Wide Web:
 

 Please provide any other questions or comments you 
 may have: