Type of company or organization? (select only one)

Select One Power generating utility Local or central government Energy advisory or planning agency Manufacture of complete cogeneration systems Manufacturers of cogeneration components and ancillary equipment Research or training establishment Large energy user Operators and installers of cogeneration equipment Owner / manager of a cogeneration site Consultants Gen-set manufacturer Other (please specify)

Please specify for Other:

What is your job function? (select only one)

Select One Administration / management Research / development Production / process / operation Quality control / assurance Purchasing Other (please specify)

Please specify for Other:

What is your purchasing influence for power products? (select only one)

Authorize     Specify     None

What is the value of goods you authorize or specify per year? (select only one)

Select One Up to US $100,000 Up to US $500,000 Up to US $5,000,000 Over US $5,000,000

What is the number of employees at your establishment? (select only one)

Select One 1-9 10-49 50-99 100-499 500-999 1,000+

In lieu of a signature, we require a personal identifier. To verify that you submitted this application please tell us the country in which you were born. (please specify)

Do you wish to receive promotional materials from Appliance or related industry suppliers via email?

Yes     No

Please check your primary job title: (select only one)

Select One Engineering & Design Manufacturing/Production Purchasing & Procurement Administrative/Corporate Management Marketing, Sales & Services Other (please specify)

Please specify for Other:

What is your primary business activity at this business location? (select only one)

Select One A/C & refrigeration equipment Household cooking equipment Electric houseware Water processing appliances Business equipment Appliance motors & controls Other appliance related manufacturing Design & engineering firm All others not in class (independent labs, trade assoc.) Heating equipment Household laundry equipment Consumer electronics equipment Commercial appliances & vending Health & Medical appliances & related products Appliance materials & non-electric components Food service companies Other (please specify)

Please specify for Other:

Please check the products that you are involved in recommending, specifying, or purchasing in any way for your company. (select all that apply)

Fasteners	Plastics/non-metallic materials
Metals	Metal parts, components, trim
Non-metallic parts & components	Controls/sensors
Cords/cord sets	Motors/air-moving devices
Finishing/metal prep. materials	Finishing equipment
Assembly equipment	Metalworking equipment
Testing equipment	Packaging/material handling equipment
Packaging Material	CAD/CAM Software
Services & Misc.	Other

Number of employees at this location: (select only one)

Select One 1 - 19 20 - 99 100 - 499 500 - 1,000 Over 1,000

What is the end product manufactured or service performed at this location? (select only one)

Select One AC & Refrigeration Equipment: AC & commercial refrigeration Household refrigerators & freezers Blowers & fans AC & heating grills/registers   Consumer Electronics Equipment: Household audio & video equipment Telephone equipment Door chimes, cord sets Radio & TV communications equipment Lighting fixtures   Other Appliance-related Manufacturing: Metal stampings Fabricated metal products Cast iron cooking utensils Aluminum cookware Porcelain enamel, paint, coil coating   Health & Medical Appliances & Related Products: Surgical & medical instruments Laboratory apparatus & furniture Optical instruments & lenses Measuring & controlling devices Electro medical & electrotherapeutic App. Ophthalmic goods Photographic equipment & supplies Watches, clocks Fitness equipment   All Other not Classified Above: Metal services center & offices Printing, publishing, & allied industries Retail distributors Trade associations Research, development & testing services   Heating Equipment: Heating Equipment, except electrical   Household Laundry Equipment: Household laundry equipment   Water Processing Appliances: Dishwashers, disposers, water heaters Stainless steel sinks Pumps & pumping equipment Whirlpool Spas   Business Equipment : Computers Computer terminals Typewriters & word processors Scales & balances, except laboratory Computer peripheral equipment Computer storage devices Photographic equipment & supplies Metal household furniture Metal office furniture Metal partitions, furniture, shelving   Appliance Materials & Non-electrical Components: Adhesives/sealants, metals, plastics   Design & Engineering Firm: Engineering Services   Food Service Companies: Food service companies   Household Cooking Equipment: Household cooking equipment   Electric Houseware: Lawn & garden equipment Electrical housewares & fans Power-driven hand tools Burglar, fire & smoke alarms Vacuum Cleaners   Commercial Appliances & Vending: Commercial-cooking, dishwashers, vacuums Automatic vending machines Commercial laundry equipment Food products machinery Calculating & ATM machines Measuring & dispensing pumps Electric hair clippers & hair dryers   Appliance Motors & Controls: Motors & generators Transformers, except electronic Drawing & insulating of nonferrous wire Relays Capacitors & condensers Switches Semiconductors & related devices Circuit boards & power supplies Controls

In order to verify your on-line subscription request, Canon Communications LLC are required to ask a personal identifying question. This information is used SOLELY for the purpose of auditing your request. What month were you born?

Select month born January February March April May June July August September October November December