Internet Retailer Free Subscription

	*Internet Retailer* is free to qualified professionals. Summary Description
	To apply for a FREE subscription to *Internet Retailer*, please answer ALL of the questions on the form below.
	The magazine publisher determines qualification and reserves the right to limit the number of free subscriptions.
	Geographic Eligibility: USA

1.	*Would you like to receive Internet Retailer?*

Yes No

2.	Internet Retailer is available in both DIGITAL and PRINT editions. How would you like to receive your issues? (select only one)

Print (USA Only) Print and Digital (USA Only)

Check here to also receive IRNewslink email newsletter for e-retailers, which includes five newsletter editions weekly and periodic product and service bulletins.

First Name:
Last Name:
Job Title:
Company:
	(Please provide your Company Name in full: abbreviations could disqualify you)
Street Address:
Suite/Floor:
City:
State:
Zip Code:
Country:
	(Note: If your country is not listed above, subscriptions are not currently available at your location.)
Phone:
Fax:
Email:
	(Note: Valid email address is required or you could be disqualified.)

Yes, please auto-fill my contact information for other publication qualification forms.

What is the approximate number of employees in your company? (select only one)

3.	Which best describes your industry? (select only one)

MERCHANT NON-MERCHANT

Retail Chain or Store Internet Service Vendor

Catalog/Direct Merchant Consultant

Virtual Merchant/Web Retailer Other

Manufacturer/Consumer Manufacturer

Wholesaler/Distributor

Consumer Services

4.	Indicate your merchant category: (select only one)

Apparel/Accessories Jewelry

Books/Music/DVD Department/Discount

Consumer Electronics Office Supplies

Flowers/Gifts Sporting Goods

Food/Drug Toys/Hobbies/Sports

Home Improvement Consumer Services

Health/Beauty Other

Home Furnishings

5.	Indicate your primary job function: (select only one)

Interactive/Network Svcs. Fulfillment/Inventory Mgmt.

MIS/Operations Financial Mgmt.

Database Services Executive/Corp. Mgmt.

Marketing E-Commerce/E-Business

Merchandising Other

6.	Indicate your title: (select only one)

Chairman/CEO/Pres/COO CMO

EVP/SVP VP

CIO/CTO Director/Dept. Mgr.

CFO Other

7.	What is your total company revenue? (select only one)

Greater than $1 billion $10 million to $100 million

$101 million to $1 billion Under $10 million

8.	To verify your request, please enter your month of birth.

Would you like to receive EMAIL notices of other print or online publications, and other relevant offers from TradePub.com?

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* Note that a valid email address is required to fulfill your request. Please verify that the email and mailing address you provided are accurate before hitting the submit button.

* The publisher reserves the right to limit the number of free subscriptions and/or reject requests based on information provided.