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      | Are you interested in using our system for: elections | on-line surveys | both ? 
      Total number of elections and surveys you may need to conduct at your organization per year:  |  
      | Size (total membership) of your group for your election or survey: |  
| How would you like us to send ballot info to your members? Email |  Email and post card |  Email and paper ballot package |  other:
 
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      | Estimated election/survey start
date: 
| end date: |  
| What is your primary reason for considering Vote-now? | if other:
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| How did you hear about our service? | if other:
 
        Referral reference code if any: 
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