1) Bresser’s will not share or resell any information you share with us.
2) We will occasionally contact you via phone, mail and or e-mail with information relative to Bresser’s products and services. All contacts will have opt out options associated with them and will be strictly adhered to.

Our goal is to build long lasting relationships with our clients and prospects by servicing them well and sharing relative information that will help facilitate the growth of their perspective businesses

• Your Name • Your Company Name • E-mail
• Telephone	FAX Number
• Address
• City	• State	• ZIP Code
If you have a Promotion Code, enter here:
How did you hear about us?	Business Associate Direct Mail Email Newsletter Past Use Search Engine Smartpages.com Trade Show Word of mouth Yellow Pages Other
If "Other", please specify:
Which of the following best describes your level of seniority?	Chairman, Owner, Partner, Executive Director, President, CEO Vice President, CFO, CIO, COO, Managing Director Director, Manager, Supervisor, Team Leader Other Management Level Title Other
Which of the following best describes your primary area of responsibility?	Corporate/General/Executive Management Engineering/Design/R&D Finance/Accounting Human Resources Information Systems/Technology/Data Processing Marketing/Sales/Advertising Manufacturing/Production/Distribution Purchasing Other
How many people does your company employ?	1 2-5 6-10 11-19 19-25 26-50 51-100 101-250 251-500 501+
Which of the following best describes your business or industry group?	Accounting/Banking/Financial Institutions Advertising/Marketing/Promotion/Public Relations Alarms/Security Services Building/Construction - Commercial Building/Construction - Residential/Improvement Computer and Data Processing Services Computer and Peripheral Equipment Distribution Computer and Peripheral Equipment Manufacturing Credit/Collection/Recovery Services Dry Cleaners Education Funeral Services Government Healthcare/Medical/Pharmaceuticals Heating & Cooling Insurance Internet/on-Line Services Landscape Design/Grounds Maintenance Law Enforcement Manufacturing (Non-Computer) Media/Publishing Mortgage Bankers & Brokers Non-Profit/Trade Association/Chamber of Commerce Painting & Interior Decorating Pest Control Plumbing Printing Real Estate - Commercial Real Estate - Residential Retail Trade/Distribution Roofing & Siding Security Dealers & Brokers Social Services Software Design/Development/Distribution Telecommunications Transportation Travel/Tourism/Entertainment Utilities Wholesale Trade/Distribution Other Business Services Other Personal Services Other
If Industry not listed, please specify:
What Bresser's product or service would you like information about?	Directories Criss Cross Plus CD-ROM Verification and Locator Service Customer Relationship Management (CRM) Bresser's List Service VoiceShot - Voice Broadcasting Printing and Mail Service Data Management Service
Comments
• Security Code Type the letters as they appear above in the box below.
If you should have any problems submitting this form, please e-mail your information to us at information@bressers.com or print this form and fax it to (313) 874-3510.