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First Name:
Last Name:
Title:
Company:
Address:
Address2:
City:
State:
Zip (+4):
Country:	(if other than US/Canada)
Phone:
Fax:
E-Mail Address:

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For audit validation purposes, on which day of the month were you born?

1. Do you purchase, approve, or recommend the purchase of information technology products and services? (Check Only One)
Yes No

2. How many people are employed in your entire organization?
(Check Only One)
20,000+
10,000 - 19,999
5,000 - 9,999
1,000 - 4,999
500 - 999
100 - 499
Less than 100

2A. How many stores are in your retail chain?
(Check Only One)
1,000+
500 - 999
250 - 499
100 - 249
50 - 99
10 - 49
1 - 9

2B. What is your total company revenue?
(Check Only One)
1 Billion +
400 - 999 Million
100 - 399 Million
50 - 99 Million
10 - 49 Million
Less than 10 Million

3. What is your primary job function? (Check Only One)
    CORPORATE MANAGEMENT
CEO/President
Partner/Owner
VP / GM
    IS MANAGEMENT
CIO/CTO
VP/Director of IS/IT
Systems Manager
Project Manager
    OPERATIONS MANAGEMENT
COO
VP/Director of Operations
CFO/Controller
Financial/Accounting Management
Sales/Business Development
Loss Prevention/Security Management
CMO/Marketing Operations
Merchandise Management/Buyer
Human Resources/Training
Warehouse/Logistics/Distribution Management
Other Professionals

4. What is your organization's primary business activity? (Check Only One)
RETAILER
Mass Merchandise
Department Store
Drug Store
Home Center/Hardware
Furniture
Apparel
Footwear
Jewelry/Accessories
Gift/Novelty/Variety
Toy/Hobby/Pet
Books/Music/Video
Sporting Goods
Electronics/Computer/Cellular/Office Supplies
Grocery
Convenience Store/Petroleum
Automotive/Aftermarket/Tires
Discount Store/Wholesale Club
Restaurant
Travel/Entertainment/Recreation
Retail Services (salon, photo, healthclub, florist, etc.)
Other Retailer
NON-RETAILER
Logistics/Financial/Merchant Services
Manufacturer
Distributor/Wholesaler
Consulting/VAR/Integrator
Media
Other

5. What are your technology interests? (Check All That Apply)
POS Software
CRM
Payment Processing
Networking/VPN
Gift/Loyalty Cards
Workforce Management
Time & Attendance
Business Intelligence
Merchandise Mgmt./Inventory Control
POS Hardware
In-Store Wireless Handhelds
Receipt Printers
Kiosks
Financial/Accounting Software
Human Resource Management
Loss Prevention/Security/Risk
E-Commerce
Supply Chain/Logistics
WMS
AIDC/Barcoding
Wireless/Mobile Computing
RFID
Digital Signage
Check Processing

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