What type of media do you publish?

Magazines
Newsletters
Other

Please describe your circulation.

Paid
Controlled
Mix of Both

Please describe your primary audience.

Consumer
Business

Is (Are) your title(s) audited?

YES - ABC
YES - BPA
YES - Other
No

Percentage Subscribers of your total circulation:

Percentage Single Copy Sales of your total circulation:

Which Distributors do you work with for Single Copy Sales? (Check all that apply)

Comag Marketing Group
Curtis Circulation Company
Kable Distribution Services
Rider Circulation Services
Warner Periodicals
Ingram Periodicals
Source Interlink
None - I need to find a distributor

Which Fulfillment house do you use?

CDS
Kable Fulfillment
Palm Coast
In House
Other

Please tell us how to contact you:

First Name
Last Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail
URL

Is there anything else you'd like to share with us before we contact you?