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What is the approximate number of employees in your company?

Select Number of Employees Less than 50 50 - 99 100 - 499 500 - 999 1,000 - 4,999 5,000 - 9,999 10,000 - 19,999 20,000 +

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1.

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2.

Title:

Select title Owner President/CEO VP Director/Manager Buyer Owner/Buyer Other Please specify for Other:

3.

What is your primary type of business?

Select business Online Retailer Independent Retailer Chain Store Mass Retailer Independent Retailer/Wholesaler Wholesaler Closeout Broker/Liquidator Distributor Dropshipper Importer/Exporter Manufacturer Reseller (Master Distributor) Other Please specify for Other:

4.

What is your primary type of store/products?

Select primary type Apparel Convenience Store Dollar Store Discount Store Drug Store Electronics Fashion Accessories General Merchandise/Variety Gifts/Collectibles Health & Beauty Housewares Jewelry / Watches Novelty Sporting Goods Toys Other Please specify for Other:

5.

Where do you primarily sell? (Please select one venue and provide the verification information requested. All information will be verified and invalid, incomplete entries will be disqualified.)

	Online (Please provide the name below of the online marketplace where you currently sell, online store name/seller id or your website address.)
	Amazon (Your valid store name is required. Invalid, incomplete entries will be disqualified.)
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	Ebay (Your valid store name or seller ID is required. Invalid, incomplete entries will be disqualified.)
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	Yahoo (Your valid store name is required. Invalid, incomplete entries will be disqualified.)
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	Your Own Website (Your company's valid, working website URL is required. Invalid, incomplete entries will be disqualified.)
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	Other Website (Please provide the URL or name of the online marketplace and a valid store name or seller ID. Invalid, incomplete entries will be disqualified.)
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	Storefront (Please provide the physical address (street, city, state and zip code) of your storefront. Your storefront address must be a business address that can be verified by online business listings. Invalid, incomplete entries and all residential addresses will be disqualified.)
	Please specify:
	Flea Market/Swap Meet (Please provide the name of the flea market/swap meet and its location (City, State). Invalid, incomplete entries will be disqualified.)
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	Kiosk/SRMU (Please provide the name of the mall/shopping center where you sell and its location (City, State). Invalid, incomplete entries will be disqualified.)
	Please specify:
	Other
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6.

What is your annual sales volume?

Select volume Under $500,000 $500,000 to $999,999 $1,000,000 to $3,000,000 $3,000,000+

7.

What is your percentage of total sales online?

Select sales 100% More than 50% Less than 50% 0%

8.

What percentage of your inventory do you purchase online?

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9.

What is your birth month? (This is required in lieu of a signature to be used only to verify your subscription request.)

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