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	Yes, I would like to become a CRMA member
	Only Fully completed forms will be processed.
First Name:	Initial
Last Name:
Company Name:
Street Address:
City:	State/Province:
Postal/Zip Code:
Country:
Business Phone:	Ext.
Fax:
Web Site Address:
e-mail:

Please answer the following questions

Which best describes the type of business at this location?

Value Added Reseller
Computer Products Retailer (Storefront)
Systems Integrator/House
Software Retailer
Mass Merchandiser/Superstore
Internet Reseller
Mail-Order Reseller
Office Products Retailer(incl. Superstores)
Consultant
Other Computer Retailer(please specify)

Your Target Customers

Small Business % of total
Medium-Sized Business % of total
Large Business % of total
Consumer % of total
Education % of total
Government % of total
Other (please specify) % of total

Tell us about your location
Type of Location:
Storefront
Corporate Office
Corporate Office with Storefront
Number of Locations for your company:

Do you provide Service? Yes No

Which best describes your job title?

Pres., Chrmn., Owner, VP, Dir., Gen., Mgr.
Purchasing Dir/Mgr./Spvsr. and Buyers
Branch/Store/Regional/District/Area Mgr.
Dept./Oprns./Service/Techn/Proj. Mgr., Assoc. and other Mgrs.
Sales/Mktg./Acct./Mgr.
Systems Spvsr/Integrator, Customer Serv. Spvsr./Mgr.
Chief/Proj./Dsgn/Syst/Applctns Eng., and other Engineering Titles
Product/Prod. Devpmt./Merchandising Mgr./Spvsr/Spclist
Sales/Mktg./Personnel
Consultant
Other (please specify)

What is your gross annual sales volume?
Under $500K
$500K to $2 million
Between $2 million and $5 million
Between $5 million and $15 million
Between $16 million and $100 million
Over $100 million

FOR AUDIT PURPOSES:

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Please give us the city you live in.

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