AIIP


First Name:
Last Name:
Email:

Company:
Address 1:
Address 2:
City:
State/Province:
Postal Code:
Country:
Phone:
Date Needed:
	Please describe your request for information below. Include The question you are trying to answer or the goal of your project; If your project needs fluency in a language other than English, please specify Does your request require the researcher to do the research in a particular location -- if so, where?
Request:
Terms and Conditions:	Based on the information provided above, AIIP will provide you with the names of up to three of our participating members who have indicated that they may be able to assist you in your research/information requirements. You can expect to receive the name, address, phone number, email, www address and a point of contact for these members within the next two business days. You may then contact these members and make your own mutually acceptable agreement or contract to have work accomplished. DISCLAIMER: AIIP's sole involvement in the AIIP Referral Program is to act as a contact facilitator. All contractual agreements for work will be negotiated and agreed upon by you and the individual member(s). AIIP does not warrant or guarantee the completion of or quality of the work provided by members. AIIP does not guarantee payment for services provided by members as a result of this program and will not participate in any way in the contractual or payment agreements or any disputes between members and their clients or potential clients resulting from this program. CERTIFICATION: In consideration of participating in the AIIP Referral Program, I agree to the terms and conditions above.
How did you hear about this service?:
Signature:
Date: