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Name *
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Job Title *
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Company *
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Address *
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City *
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State*
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Zip*
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Country
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Telephone
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FAX
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| The rest of this form is mandatory in order to process your request |
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What state were you born in? (This will act as your signature.)*
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1. What products are you most interested in purchasing? |
Lighting/Lighting Controls
Safety / Training
Wire & Cable |
Power Quality
Tools & Testers |
| 2. Primary Business of Your Company or Employer |
Electrical Contracting / Low Voltage Contracting includes power (inside, line, lighting, maintenance, control, etc.) electrical work, and/or all VDV, security, fire/life safety, fiber optics, home/building automation systems, and integrated building system applications
Engineering/Consulting
Systems Integration
Wholesale/Distributor
Other
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| 3. Primary Job Title or Function |
Executive Management: Owner, Partner, President, VP, General Manager, etc.
Management: Project Manager, Superintendent, Supervisor, Foreman, etc.
Electrician (field), Journeyman, Technician, Installer, Service Person, etc.
Designer, Electrical Engineer,
Estimator
Purchasing Agent, Buyer
Other
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| 4. Building Components You or Your Company Have Installed (Check all that apply) |
Security (includes CCTV, Access/Motion/Intrusion Systems)
Building, Automation Control Systems (includes HVAC, Lighting)
Fire Life Safety Systems
Fiber Optics/Comm Systems(VDV) / Premise Wiring
Power Quality Systems (Standby, Co-gen, etc.)
None of the Above
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| 5. Total Number of Employees |
1-9
10-19
20-34 |
35-49
50+ |
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| 6. What types of work does your company perform? |
Commercial
Residential
Industrial
Institutional |
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