Name
Email
Country
Department
Job Title
Phone
Fax
Company Name
Street 1
Street 2
City
State/Province
Zip Code

How would you like to be contacted?

	Mail			Call to tell me more
	E-mail			Call to arrange an appointment soon
	GET IN HERE NOW!

How did you hear about KODAK Dynamic Images?

	Magazine article			Trade Show			Internet
	Advertising / Direct Mail			Saw a Dynamic Image			Word of Mouth

Other (please specify)   

How are you considering using KODAK's Dynamic Imaging technology?

	Point of Purchase			Promotion			Advertising
	Direct Mail			Premuim			Packaging
	Posters			Collectables			A component of your own product
	Display

What KODAK Dynamic Image effects are you interested in?

	KODAMOTIONTM			Morphing			3D
	Flips			Zoom			Combinations of these effects

What industry(s) do you currently work with?

	Automotive			Packaged Goods			Apparel
	Entertainment			Pharmaceutical			Food and Beverage
	Sports

Other (please specify)   

If you have a specific program in mind, what is the timing?
   Less than 4 weeks   
   1-3 months   
   4-6 months   
   More than 6 months   

What quantity of KODAK Dynamic Images are you considering for this program?
   Less than 100   
   100 - 1,000   
   1,000 - 10,000   
   10,000 - 100,000   
   Over 100,000   

Approximately what size are you considering for this KODAK Dynamic Image?

	Less than 1 in. square			About 2 x 2 in.			Credit card size
	About 4 x 5 in.			8 x 10 in.			12 x 24 in.
	24 x 36 in.			40 x 50 in.			Over 40 x 50 in.

What is the approximate budget for the project you're considering?
   Less than $15,000   
   $15,000 - $50,000   
   $50,000 - $100,000   
   Over $100,000   
   Have not yet determined budget