Complete and verifiable information is required in order to qualify for this Subscription.

First Name: Last Name:   Job Title:   Company Name:   Business Email: Phone: Fax:

Division/Mail Stop: Street Address: City: State/Province: Select for USA, Canada, or Mexico 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 American Samoa Guam Marshall Islands Micronesia (Federated States of) Palau Puerto Rico U.S. Minor Outlying Islands U.S. Virgin Islands Northern Mariana Islands Armed Forces Americas AA Armed Forces Middle East, Europe, Canada AE Armed Forces Pacific AP Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Aguascalientes Baja California Baja California Sur Campeche Coahuila Colima Chiapas Chihuahua Distrito Federal Durango Guanajuato Guerrero Hidalgo Jalisco Michoacan Morelos Nayarit Nuevo Leon Oaxaca Puebla Queretaro Quintana Roo San Luis Potosi Sinaloa Sonora Tabasco Tamaulipas Tlaxcala Veracruz Yucatan Zacatecas Other Postal/ZIP Code: Country: Select Country UNITED STATES CANADA INDIA UNITED KINGDOM == AFGHANISTAN ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTARCTICA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN AZORES BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BR VIRGIN ISLAND BRAZIL BRITISH INDIAN OCEAN TERRITORY BRUNEI BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANARY ISLANDS CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REP CHAD CHANNEL ISLANDS CHILE CHINA, PEO REPBL CHRISTMAS ISLAND COCOS (KEELING) ISLANDS COLOMBIA COMOROS CONGO CONGO, THE DEMOCRATIC REPUBLIC OF THE COOK ISLANDS COSTA RICA COTE D'IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR ELAND ISLANDS EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FALKLAND ISLANDS FAROE ISLANDS FIJI FINLAND FRANCE FRENCH GUINEA FRENCH POLYNESIA GABON, REPUBLIC OF GAMBIA GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUERNSEY GUINEA BIASSAU GUINEA,REPUBLIC OF GUYANA HAITI HONDURAS HONG KONG HUNGARY ICELAND INDONESIA IRAN IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KOREA,DEMOCRATIC REPUBLIC OF KOREA,REPUBLIC OF KOSOVO KUWAIT KYRGZSTAN LAOS LATVIA LEBANON LESOTHO LIBERIA LIBYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAU MACEDONIA MADAGASCAR MADEIRA MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE MEXICO MICRONESIA MOLDOVA MONACO MONGOLIA MONTENEGRO MONTSERRAT MOROCCO MOZAMBIQUE NAMIBIA NAURU ISLANDS NEPAL NETHERLANDS ANTILLES NETHERLANDS NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NORFOLK ISLAND NORTHERN MARIANA ISLANDS NORWAY OMAN PAKISTAN PALAU PALESTINIAN TERRITORY, OCCUPIED PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES POLAND PORTUGAL QATAR REPUBLIC OF KIRIBATI REUNION ROMANIA RUSSIAN FED RWANDA SAINT PIERRE AND MIQUELON SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOCIETY ISLANDS SOLOMON ISLANDS SOMALIA,REPUBLIC SOUTH AFRICA SPAIN SRI LANKA ST KITTS ST LUCIA ST VINCENT SUDAN SURINAM SWAZILAND SWEDEN SWITZERLAND SYRIA TAHITI TAIWAN TAJIKISTAN TANZANIA THAILAND TIMOR-LESTE TOGO TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU UGANDA UKRAINE UNION OF MYANMAR UNITED ARAB EMIRATE UNITED KINGDOM,ENGLAND UNITED KINGDOM,NO.IRELAND UNITED KINGDOM,SCOTLAND UNITED KINGDOM,WALES URUGUAY UZBEKISTAN VANUATU VATICAN CITY VENEZUELA VIETNAM, RPBLC OF VIRGIN ISLANDS, U.S. WALLIS AND FUTUNA WESTERN SAHARA WESTERN SAMOA YEMEN ZAMBIA ZANZIBAR ZIMBABWE OTHER

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

Your offer confirmation will be sent to your business email address entered above.

---

1.

Do you wish to receive a FREE introductory subscription to CM/Cleaning & Maintenance Management®?

Yes     No

2.

Please specify the type of subscription you prefer:

	Print Edition (USA/Canada/Mexico Only)
	Digital Edition (all qualified subscribers)
	CM/Cleaning & Maintenance Management® Magazine is now available in an environmentally-friendly digital edition. All qualified subscribers are eligible to receive a FREE introductory subscription in the digital format. Only qualified subscribers in the United States, Canada and Mexico are eligible to receive a free introductory subscription to the print version.

3.

Do you wish to receive a FREE email subscription to CM e-News Daily™ service?

Yes     No

4.

Business Activity:

Select business activity Building Service Contractor/Contract Cleaner School/College/University Hospital/Sanitarium/Rest Home/Nursing Home Office Building/Government Building Hotel/Motel/Apartment Building Retail-Commercial Building/Club/Airport/Church/Auditorium Industrial Plant/Manufacturing Plant Other Please Specify for Other:

5.

Job Function:

Select job function Director Physical Plant Facility Director Environmental Services Superintendent Buildings and Grounds Director of Maintenance Building/Facilities Engineer Executive Housekeeper Manager Building Services Building Maintenance Manager Physical Plant Administration Custodial/Maintenance Supervisor Business Owner or Manager Sales Manager/Representative Property Maintenance Manager Other Please Specify for Other:

6.

Purchasing Authority?

Select purchasing authority Sole Purchasing Decision Maker Specify/Recommend Purchases Approve Purchases Not Involved

7.

Annual Purchases (Equip. Materials & Supplies):

Select annual purchases Over $1 million per year $500,000 to $1 million per year $250,000 to $499,999 per year $100,000 to $249,999 per year $50,000 to $99,999 per year $20,000 to $49,999 per year $10,000 to $19,999 per year Less than $9,999 per year

8.

Number of Employees:

Select Number of Employees 50,000+ 20,000 - 49,999 10,000 - 19,999 5,000 - 9,999 2,500 - 4,999 1,000 - 2,499 500 - 999 250 - 499 100 - 249 50 - 99 25 - 49 10 - 24 5 - 9 1 - 4

9.

Average Square Feet Cleaned per Month:

Select square feet 5,000,000 or more 3,000,000 - 4,999,999 1,000,000 - 2,999,999 500,000 - 999,999 100,000 - 499,999

10.

Grand View Media Group's circulation is audited by an independent company that ensures Grand View Media Group's circulation figures are accurate. To verify your subscription, what month were you born?

Select month born January February March April May June July August September October November December

---

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

Yes     No

Sign up for special offer alerts from select partners featuring the latest products and services you are interested in.

Yes     No