Internet Retailer Free Subscription

	*Internet Retailer* is free to qualified professionals. Summary Description
	To apply for a FREE subscription to *Internet Retailer*, please answer ALL of the questions on the form below.
	The magazine publisher determines qualification and reserves the right to limit the number of free subscriptions.
	Geographic Eligibility: USA, Canada

1.	*Do you wish to receive a FREE subscription to Internet Retailer?*

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First Name:
Last Name:
Job Title:
Company:
	(Please provide your Company Name in full: abbreviations could disqualify you)
Street Address:
Suite/Floor:
City:
State:
Zip Code:
Country:
	(Note: If your country is not listed above, subscriptions are not currently available at your location.)
Phone:
Fax:
Email:
	(Note: Valid email address is required or you could be disqualified.)

What is the approximate number of employees in your company? (select only one)

Yes, please auto-fill my contact information for other publication qualification forms.

2.	Which category best describes your industry? (select only one)

Retail Chain or Store University/School/Library

Catalog/Direct Merchant Consultant

Internet Service Manufacturer Other

Virtual Merchant Other

3.	If you answered Retail Chain or Store above, please specify what type: (select only one)

Department Store/General Merchandiser Food/Drug

Discount Home Center/Hardware

Specialty Other

4.	Please indicate your primary job function: (select only one)

Interactive/Network Services Fulfillment/Inventory Management

MIS Financial Management

Database Services Executive

Marketing Other

Merchandising

5.	Please indicate your title: (select only one)

Chairman/CEO/President/COO VP

EVP/SVP Director/Department Manager

CIO Other

CFO

6.	In lieu of a signature, we require a unique identifier to be used only to verify this subscription request. On what day of the month were you born?

Would you like to receive EMAIL notices of other print or online publications, and other relevant offers from TradePub.com?

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Related FREE Offers from TradePub.com: Check those you wish to receive.

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What is your projected annual online revenue? (select only one)

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$10M - $25M Not sure/Can't disclose

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What best matches the number of employees in your business? (select only one)

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