Name
Company
Phone
Email
Address
City
State/Zip
What is the position(s) you are trying to fill?
Customer Service Representative
Technical Support Representative
Webmaster
Computer Programmer
Remote Receptionist
Data Entry Person
Telemarketer
Virtual Assistant
Other Not Listed (Specify Below)
What is your approximate budget per month for this position?
(Does not need to be exact, just a rough estimate.)
Less Than $500
$500 - $799
$800 - $999
$1000 - $1499
$1500 or more
Description of Requirements   (Please include bulleted points for main requirements.)
Questions