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FIRST NAME* LAST NAME* COMPANY NAME* ADDRESS* CITY* STATE** Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming PROVINCE** ZIP*    COUNTRY* United States Canada TELEPHONE* FAX* EMAIL* WEBSITE SUBSCRIPTION PLAN $60.00 1 year - 6 issues

STORE TYPE Corporation Sole Proprietor Chain Franchise Home Based Other NUMBER OF STORES 1 2 3 4 5 6 7 8 9 10+ SIZE OF STORE 500-899 sf 900-1499 sf 1500-1999 sf 2000-2999 sf 3000-3999 sf 4000 sf+ % STORE USED FOR SCRAPBOOKING 25%  50%  75%  100% BUSINESS TYPE Retailer Wholesaler Publisher Designer/Pro.Crafter Other ESTIMATED YEARLY SALES under $50K $50-99K $100-249K $250-500K $500-1Mil $1Mil-5Mil WHOLESALE INVENTORY $25-49K $50-74K $75-99K $100-149K $150-199K $200-299K $300K+ HOW LONG IN BUSINESS STOREFRONT yes  no  Opening A Store? Tax ID # VENDOR LICENSE # BUYING GROUP AFFILIATION HOW DID YOU HEAR ABOUT US?

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