Request for Electronic Retailer Magazine Subscription

Name: 
Company: 
Title:  
Address:  
Address 2:  
City:  
State:  
Zip:  
Phone: 
Ext.: 
Fax: 
Email: 
 Yes, Subscribe to magazine - Electronic Retailer   
 Yes, Subscribe to e-newsletter - Electronic Retailer News Direct   

Are you a member of the Electronic Retailing Association?  Yes No

Would you like information on the Electronic Retailing Association?  Yes No

Are you a member of a national or international trade association?
 Yes, please specify:
 No


Electronic Retailer is an audited publication. Please answer one of the following questions to secure that this subscription will be delivered to your name and address only.


An educational and resourceful publication is created for active readers. Please help us to serve this industry better by telling us about yourself and your interest in the electronic retailing and direct marketing industry:

How many people are employed by your company?  
How long has your company been in business? 
If applicable, how many people do you manage? 


What segment of electronic direct marketing or retailing interests you? Please select all that apply.
 Media Buying
 Products
 Fulfillment
 Tele-services
 Production
 Direct Mail
 Print Media
 Agency Services
 Interactive Media
 Interactive Television
 Internet Search Engines
 Online Retailing
 Online Marketing
 Finance
 Legal

Which of the following best describes your business? Please select all that apply.
 Retailer
 Fortune 500 Company
 Television Network
 Cable Network
 Internet Retailer
 Service Provider
 Agency
 Media Buyer
 Consultant
 Import/Export
 Inventor

For verification, please enter the following below: captcha

19 Feb 09