Instructions: Place an "X" in the appropriate boxes. For additional information, use the space provided at the bottom. The purpose is to gather detailed information about your company to complete your formal Telework program quote. Please respond with as much information as possible. There are several categories listed and we ask that you complete the questions within each category. This is to ensure there will be no conflict of internal policies, procedures, and practices. All information will be kept strictly confidential. Upon receipt of this questionnaire, you will be provided with a general quote.

Note: This quote is an estimate and may be changed based on obtaining further information regarding your Telework expectations.

The information Provided above will be used for the sole purpose of providing a quote for a custom Telecommuting/Telework Program, Policy, and Training Development. The actual cost of implementation may be more or less depending on the additional amount of information gathered after a representative of our company discusses this form with you. We will make every effort to provide an accurate estimate, but it is impossible to determine the exact cost from this questionnaire. Many times we discover you may not need as much as originally planned. This is where our custom approach can save you enormous amounts of time and money.