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Company Information
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Company:
Organization DBA:
Website:
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Are you a Non-Profit Org:
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Season of Operation:
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No
Yes
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Year Round
Summer Only
May - October
Other
Please Specify:
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Industry (please select most appropriate):
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Assisted Living/Retirement Home
BSA
BSA Camp
Business
Camp
Camp and Retreat
Camp, Conf Center and Church
Camp, Conf Center and Retreat
Casino
Catering
Childcare/Daycare
Church
Church and Ministry
Church and School
Community Agency
Conf Center
Conf Center and Camp
Conf Center and Inn
Conf Center and Retreat
Country Club/Golf Course
Farm
Government Service Agency/GSA
Government/Military
Household/Family
Inn/Hotel/Motel
Medical Services/Clinic/Hospital
Ministry
Musician/Band
Not For Profit
Resort
Restaurant
Retreat
Retreat and Ministry
Salvation Army
Salvation Army, Camp
Salvation Army, Conf Center and Camp
School
School and Camp
Synagogue
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TBN Rep
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YMCA
YMCA and Camp
Physical (Shipping) Address
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Address:
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City:
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State/Province:
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Zip code:
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Country:
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USA
CANADA
My Organization Has Multiple Shipping Addresses
Alternate Physical (Shipping) Address
Address:
City:
State/Province:
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
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Hawaii
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Ohio
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Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Prince Edward Island
Saskatchewan
Ontario
Quebec
Yukon
Zip Code:
Country:
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USA
CANADA
Mailing (Billing) Address
Same as Shipping:
*
ADDRESS:
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City:
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State/Province:
Select
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
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Prince Edward Island
Saskatchewan
Ontario
Quebec
Yukon
*
Zip Code:
*
Country:
-None-
USA
CANADA
Primary Contact Information
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Salutation:
*
First Name:
*
Last Name:
*
Title:
-None-
Brother
Dr.
Fr.
Miss
Mr.
Mrs.
Ms.
Pastor
Prof.
Rev.
Sister
*
Email:
*
Phone:
Fax:
Mobile:
What is your Preferred Method of Communication?
-None-
Email
Telephone
Mobile Phone
Any
*
Do you have a different person who represents Accounts Payable?
-None-
Yes
No
Please Enter Accounts Payable Contact Information:
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Salutation:
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Brother
Dr.
Fr.
Miss
Mr.
Mrs.
Ms.
Pastor
Prof.
Rev.
Sister
*
First Name:
*
Last Name:
Title:
*
Email:
*
Phone Number:
Mobile Number:
Fax Number:
Additional Information
*
How did you hear about us?
-None-
Advertisement
Conference
Contacted by a Representative
Employee Referral
Mailing
News Article
Other
Partner Referral
Referred by Current Network Member
Trade Show
Vendor Referral
Website/Search Engine
Word of mouth
Please Specify:
*
Network Representative:
Select
Unsure/None , 199
Alan Williams , 380
Bill Pitcher , 200bp
Brian Crabb , 200bcrb
Daniel Rotch , 200dr
Jeremy McKeen , 200jm
Lance Wagar , 375
Lee Dickerson , 200ld
Mike Silver , 200
Sean Adam , 200sa
Shawn Foster , 339
Scott Stewart , 385
USCJ (United Synagogue of Conservative Judaism) , 200uscjap
Notes:
General Purchasing Information
Food:
Approximately what is your annual volume for food purchases?
$
Office Supplies:
*
Who is your current Office Supplies provider?
(To select multiple options please hold "control" button
or hold "command" button on Mac.)
Office Depot
Quill
Staples.com
Staples Advantage
Eway
OfficeMart.com
Union Office
Amazon
Sam’s Club
Walmart
WB Mason
Other
Approximately what is your annual volume for office products?
$
Would you like to be set up with one of our Office Supply vendors to save more money?
We will determine which of our vendors will best meet your needs.
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Agreement Terms and Submission
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Membership Agreement and Participation Statement.