Utility Products Free Subscription

	*Utility Products* is free to qualified professionals. Summary Description
	To apply for a FREE subscription to *Utility Products*, 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, Mexico

1.	*Do you wish to receive a FREE subscription to Utility Products?*

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:
Department/Mail Stop:
City:
State/Province:
Country:
	(Note: If your country is not listed above, subscriptions are not currently available at your location.)
Zip/Postal Code:
Email Address:
	(Note: Valid email address is required or you could be disqualified.)
Business Phone:
Business Fax:

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

2.	Primary Business: (select only one)

Electric Utility Telecom Contractor

Municipality CATV Contractor

Telephone Company Dealers/Distributors

Cable/CATV Company Service/Repair/Maintenance

Industrial/Commercial Contractor Other (please specify)

Overhead/Underground Contractor

3.	Primary Job Function: (select only one)

General/Corporate Management Fleet Management

Engineering: Design, Specifying, Safety Other (please specify)

Electric Maintenance and Line Supervision

Purchasing

4.	Number of Employees at all of your locations? (select only one)

50 or less 501 - 1,000

51- 100 1,001 - 5,000

101 - 500 5,001 or more

5.	The value of the equipment you recommend, specify or purchase annually? (select only one)

$0 - $99,999 $1,000,000 - $1,999,999

$100,000 - $499,999 Over $2,000,000

$500,000 - $999,999

6.	Products You Purchase/Specify/Recommend: (select all that apply)

Safety Products Utility Vehicles & Accessories

Tools & Supplies Overhead Distribution Equipment

Repair/Maintenance/Testing Underground Distribution Equipment

Wire & Cable Handling Equipment Metering Devices

Test & Measurement Equipment Power Monitoring

Transmission & Distribution Other

T&D Automation None of the Above

7.	Do you wish to receive Product Showcase e-Alert monthly e-newsletter?

Yes No

PERSONAL IDENTIFIER: Audit Verification (Required) In order to verify your request for this publication, without the availability of a signature PennWell Corporation's audit bureau requires that they ask a personal identifying question. This information is used solely for the purpose of auditing your request. What is your favorite sport?

9.	Do you wish to receive print or digital?

Print Digital

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

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* Note that a valid email address is required to fulfill your request. Please verify that the email and mailing address you provided are accurate before hitting the submit button.

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