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Personal Information Your Name: Your E-mail Address: Your Phone Number: Your Company Information Company Name: Company Address: City: State/Province: SELECT Alberta British Columbia Manitoba Newfoundland Ontario Prince Edward Island New Brunswick Nova Scotia Quebec Saskatchewan Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennesse Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ZIP/Postal Code: Phone Number: Fax Number: More about your company ... What is the nature of your business? Pls. Choose Manufacturing Retailer Wholesale Legal Medical Real Estate Organization Accounting and Finance Professional Other Please give us a brief description of the products and or services your company provides How does your company attract new customers? Please check all that apply: Newspaper Advertising Telemarketing Fax Radio Direct mail TV Yellow Pages Press release Catalogues Word of Mouth Fax broadcasting Networking Trade publications Press releases Cold calling Other directories Brochures Other   Do you make the advertising or marketing decisions for your company? Yes   No If you are not the person who makes the marketing and advertising decisions for your company, could you please tell us who is the primary person to contact: Contact Name: Phone Number: Email Address:   What are your expectations from the promotional activities that you are involved with?   Does your company currently have a web site?  Yes  No If you have a WEB site what is your URL? HTTP:// Please provide us with any additional information that you feel might assist us in helping us meet your needs:   I would prefer you contact me directly by telephone  or email