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1. * Primary Job Title
   Select One Engineering & Design Manufacturing/Production Purchasing & Procurement Administrative/Corporate Management Marketing, Sales & Services Other (Please Specify In Box)
   

2. * Please check the products that you are involved in recommending, specifying, or purchasing in any way for your company (check all that apply)
   Fasteners
   Plastics/Non-Metallic Material
   Metals
   Metal Parts, Components, Trim, & Hardware
   Non-Metallic Parts & Components
   Controls/Sensors
   Cords/ Cord Sets
   Motors/Air-Moving Devices
   Finishing/Metal Prep Material
   Finishing Equipment
   Assembly Equipment
   Metalworking Equipment
   Testing Equipment
   Packaging/Material Handling Equipment
   Packaging Material
   CAD/CAM Software
   Services & Misc
   Other (Please Specify In Box)
   

3. * What are the business activities at this business location?  (Check all that apply)
   Air Conditioning & Refrigeration Equipment
   Heating Equipment
   Household Cooking Equipment
   Household Laundry Equipment
   Electric Housewares & Portable Appliance
   Consumer Electronics Equipment
   Water Processing Appliances & Other Consumer Appliances
   Commercial Appliances & Vending Machines
   Business Equipment
   Health and Medical Appliances & Related Products
   Appliances Motors & Controls
   Other Appliance - Related Manufacturers
   Appliance Materials & Non-electrical Components
       -- Non-Manufacturing --
   Design and Engineering Firms
   Food Service
   All Others Not Classified Above
   Other (Please Specify In Box)
   

4. * Please choose the one category that best describes the primary business activity (choose one only)
   Select One Air Conditioning & Refrigeration Equipment Heating Equipment Household Cooking Equipment Household Laundry Equipment Electric Housewares & Portable Appliance Consumer Electronics Equipment Water Processing Appliances & Other Consumer Appliances Commercial Appliances & Vending Machines Business Equipment Health and Medical Appliances & Related Products Appliances Motors & Controls Other Appliance - Related Manufacturers Appliance Materials & Non-electrical Components     -- Non-Manufacturing -- Design and Engineering Firms Food Service All Others Not Classified Above Other (Please Specify In Box)
   

5. * What is the Primary End Product Manufactured or Service Performed at This Location? (Please Be Specific)
   

6. * Number of Employees at This Location:
   Select One 1-19 20-99 100-499 500-1000 OVER 1000

7. If you are responding from a cover wrap or bind-in card, please select the corresponding promo code below.
   Select One 1772 E672

8. *In order to verify your on-line subscription request, we are required to ask a personal identifying question. This information is used SOLELY for the purpose of auditing your request.
   
   What state were you born in?