Business / Industry
First Name
Last Name
Job Title
Company Name
Department / Mail Stop
Street Address
City
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State / Province / District
ZIP / Postal Code
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Business Telephone	ext
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QUALIFICATION FORM

Incomplete forms will not be processed. A complimentary subscription to Construction Distribution will be sent to those applicants who qualify. The publisher reserves the right to limit the number of subscriptions accepted.

1.	I wish to receive Construction Distribution magazine FREE of charge.

Yes!

No

NOTE: In order to be considered for a subscription to Construction Distribution, you MUST select Yes above. If you do not select Yes, you will not receive a complimentary subscription to Construction Distribution.

2.	Please indicate the type of distributorship at this location: (Check only one.)

Contractor Supplies and Rental

Contractor Supplies Only

Contractor Rental Only

Contractor/Industrial Supplies

Fastener Specialist

DIY - Hardware/Home Centers - Selling and Renting to Professional Contractors

Lumberyards/Building Material Supplies

Other (please specify)

3.	Please fill in the category that best describes your job title? (Check only one.)

Corporate and Operating Management (Owner, President, Partner, VP, General Manager and related personnel)

Sales Management (VP of Sales, Sales Mgr, Regional, Divisional, Branch & Territory Mgrs., Marketing Mgrs., andrelated personnel)

Sales Support Personnel (Inside/Outside Sales, Counter Sales, Customer Service Reps and related personnel)

Purchasing Management and Purchasing Support Personnel (Purchasing Agent/Mgr., Buyers and related personnel)

Rental Manager

Other (please specify)

4.	How many employees are at this location?

5.	How many branch locations of this company?

6.	Please fill in the associations in which your company is a member or has a membership: (fill in all that apply)

ARA

STAFDA

GISMO

NFDA

ISA

7.	What product lines are normally stocked at this location: (fill in all that apply)

8.	Do you wish to receive Product or Service information from our Industry partners via e-mail:

Yes

No

9.	In order to verify your request for this publication, without the availability of a signature, our audit bureau requires that we ask a personal identifying question. This information is used solely for the purpose of auditing your request. What month were you born?

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