Private Label Buyer Free Subscription

	*Private Label Buyer* is free to qualified professionals. Summary Description
	To apply for a FREE subscription to *Private Label Buyer*, 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

1.	*Do you wish to receive a FREE subscription to Private Label Buyer?*

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)
Address:
Dept/Mail Stop/Suite:
City:
State/Province:
Zip Code/Postal Code:
Country:
	(Note: If your country is not listed above, subscriptions are not currently available at your location.)
Email Address:
	(Note: Valid email address is required or you could be disqualified.)
	By providing your email address you grant permission to contact you via email regarding your subscription and other products/services.
Business Phone:
Business Fax:*
	*By providing your fax number you grant permission to contact you via fax regarding your subscription and other products/services.

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.	What is your type of business? (select only one)

Supermarket Chain Club Store/Mass Merchandiser

Convenience Store Chain Broker

Grocery Wholesaler Manufacturer/Supplier

Drug Store Chain Association, School, Library

Discount Store Chain Other (please specify)

Gen Merchandise/Variety Chain

3.	What category best describes your job title? (select only one)

Administrative, Management, Chairman of the Board, Owner, Partner, President, CEO, COO, CFO, Secretary, Treasurer, Executive Vice President, Vice President, General Manager, Division Manager, Director
Buyer-Merchandiser, Merchandise Manager, Purchasing Manager, Head Buyer, Asst Buyer, Department Manager, Category Manager, Store Manager, Sales/Marketing Manager
Other (please specify)

4.	How many stores does your company operate? (select only one)

1-10 stores 50-149 stores

11-49 stores 150 or more stores

5.	My primary buying responsibilities are: (select all that apply)

Food HBC

Non-food Frozen

General Merchandise

6.	What is the approximate dollar volume of your company's private label sales? (select only one)

Less than $10 million $10-$50 million Over $50 million

7.	What is your buying responsibility? (select only one)

Authorize/Approve Purchase Specify/Recommend/Influence Purchase No Purchasing Influence

8.	In lieu of a signature, we require a unique identifier used only for subscription verification purposes. What is your date of birth?

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* The publisher reserves the right to limit the number of free subscriptions and/or reject requests based on information provided.