1.	Do you wish to receive a FREE subscription to Performance Business?

Yes     No

First Name:
Last Name:
Job Title:
	(Ex: Director, Vice President, Project Manager, etc.)
Company:
	(Please provide your Company Name in full: abbreviations could disqualify you)
Street Address:
Dept/Mail Stop/Suite:
City:
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Yes, please auto-fill my contact information for other publication qualification forms.

2.	Your Primary Business Category: (select only one)

Performance Retailer/Speed Shop	4x4/Off-Road Center
Automotive Parts Store	Performance Warehouse Distributor
Engine Builder/Machine Shop/Fabricator	Manufacturer/Importer of Performance Products
Hot Rod/Muscle Car Center	Other (please specify)

3.	Number of Employees: (select only one)

1-3	11-25
4-10	More than 25

4.	Annual Sales Volume: (select only one)

Up to $100,000	$500,001 - $1 Million
$100,001 - $250,000	$1,000,001 - $5 Million
$250,001 - $500,000	More Than $5 Million

5.	Function: (select only one)

Senior Management (President/Owner/CEO)	Sales
Management	Installation/Fabrication
Purchasing	Other (please specify)

6.	In Business Since (Year): (please specify year)

7.	Does your business sell and/or install automotive performance products?

Yes     No

8.	Does your business have a retail showroom?

Yes     No

9.	Does your business purchase products from a warehouse distributor?

Yes     No

10.	My business offers the following products and services: (select all that apply)

Hardcore Racing Products	Product Installation/Tuning Services
Street Performance Products	Machining and/or Fabrication Services
Sport Compact/Import Tuning Products	Off-road/4x4 products
Hot Rod and/or Muscle Car Products	Mobile electronics/on-board technology

11.	My business sells and/or installs: (select all that apply)

Air Filters	Ignition Systems
Anti-Sway Bars	Instrument Panels/Gauges
Brake Components	Intake Manifolds
Clutches	Nitrous Oxide Systems
Computer Chips	Racing Apparel
Exhaust Systems	Safety Equipment
Fuel Systems	Superchargers/Turbochargers
Tools/Garage Accessories	Suspension Components
Headers	Wheels and Tires

12.	How many siblings do you have? (Required by our circulation auditors in lieu of a signature)

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

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Would you like to receive relevant information from TradePub.com on behalf of third party businesses/organizations?

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