%%\listfiles
\documentclass[legalpaper, 10pt]{article}
\usepackage{palatino}
\usepackage{multido,graphicx,xcolor}
\pagestyle{empty}
\setlength{\textwidth}{72.5mm}
\setlength{\textheight}{356mm}
\setlength{\oddsidemargin}{0mm}
\setlength{\evensidemargin}{-5mm}
\setlength{\topmargin}{-5mm}
\setlength{\headheight}{0pt}
\setlength{\headsep}{0pt}
\setlength{\footskip}{0pt}
\parindent=0pt
\newlength{\omrx}
\setlength{\omrx}{0.1mm}

%% identifying information
\newcommand{\infoline}{\textcolor{black} {ACME NATURAL RESOURCES CORP.\\
Widget Development Project EIS\\
Jan 06, 2006 }}

%% number of questions (rows)
\newcommand{\nR}{28}

%% strobe marking boxes
\def\strobe{\rule{3mm}{2.54mm}}

%% \color{red!70}

\def\OLeft{\scalebox{0.8}[0.6]{\large O}}

\begin{document}

\sffamily\small

\bigskip

%% Participant group
\hspace{6mm}In general, I consider myself to be:\\
  {\strobe}\hspace{3mm}Supporting \hspace{2mm} \framebox[3mm]{}\\
  {\strobe}\hspace{3mm}Neutral \hspace{7.5mm} \framebox[3mm]{}\\
  {\strobe}\hspace{3mm}Opposing \hspace{4mm} \framebox[3mm]{} \hspace{2mm}
  \hspace{8mm}the project.

\vspace{5mm}

\hspace{6mm}Category of Components:\\
{\strobe}\hspace{4mm}Environmental %
  \hspace{1mm} \framebox[3mm][centered]{}\\
  {\strobe}\hspace{4mm}Economic \hspace{7.5mm} \framebox[3mm][centered]{}\\
  {\strobe}\hspace{4mm}Societal \hspace{10mm} \framebox[3mm][centered]{}

\vspace{5mm}
%% Overall headings
%% \small
\hspace{25mm} PREFERENCE

%% \vspace{3ex}

%% Put headings on columns
\hspace{5mm}\hspace{0.1\omrx}\multido{\nColumn=1+1}{9}{\makebox[7mm]{\nColumn}} %
\hspace{0.1\omrx} %
Inv

\vspace{1ex}

%% Make nR rows of scoring boxes for answers
  \multido{\nRow=1+1}{\nR}{ %
     {\strobe}\hspace{3mm}\makebox[0.1\omrx]{\nRow}
     \multido{}{10}{\framebox[7mm]{}}}

\vspace{12.5mm}

%% footer
\parbox[t]{1.0\textwidth}{\infoline} %

\vspace{6mm}

\parbox[t]{1.0\textwidth}{\includegraphics[scale=0.5]{aesi-logo}}

{\textcolor{black}{\footnotesize{\copyright 2006 Applied Ecosystem Services, Inc.}}}
\end{document}