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First Name:
Last Name:
My job title is:
Company Name:
Company Address:
Address (Line 2):
City:
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Postal Code:
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Email:	(Email addresses will not be sold)
1. Primary Business Activity
If other please specify:
2. Company Job Activities (check ALL that apply)
Plumbing Hydronic Heating Drain Cleaning/Inspection Fire Protection Air Conditioning Ventilation/Sheet Metal Controls/Instrumentation Refrigeration Warm Air Heating Electric Oil Gas Infra-red Other (please specify)
3. Do you specify, select or approve the purchase of any of the following types of products? (Check ALL that apply)
Plumbing Hydronic Heating Fire Protection Air Conditioning Ventilation/Sheet Metal Controls & Instrumentation Refrigeration Warm Air Heating Fireplaces None of the above
4. What markets are you active in? (Check ALL that apply)
Residential Industrial New Construction Commercial Institutional Retrofit/Replacement Other (please specify)
5. How many employees at this location?

6. For auditing purposes:
What month were you born in?