Internet Retailer Free Renewal Subscription

	Yes! I want to renew my subscription to Internet Retailer for one year. *
	No.

Please answer all questions completely. The publisher reserves the right to limit the number of free subscriptions.

In lieu of a signature, we require a unique identifier to be used only to verify this subscription request.

On which day of the month were you born? *

I. ADDRESS

Please list your name, title, company and business address below (no P.O. boxes, please). By providing your e-mail address, you are also renewing to IRNewsLink, Internet Retailer’s e-mail news service.

First Name *	City *
Last Name *	State *	Zip Code *
Title *	Phone
Company *	Fax
Street Address *	Email *
Suite / Floor	Confirm Email *

II. INDUSTRY *

Which category best describes your industry? (Choose only one)

	Retail Chain or Store
	Catalog/Direct Merchant
	Internet Service
	Virtual Merchant / Web Retailer
	University/School/Library
	Consultant
	Manufacturer
	Wholesaler / Distributor
	Other

III. RETAIL TYPE *

If you answered Retail Chain or Store above, please specify what type: (Choose only one)

	Department Store/General Merchandiser
	Discount
	Specialty
	Food/Drug
	Home Center/Hardware
	Other

IV. JOB FUNCTION *

Please indicate your primary job function: (Choose only one)

	Interactive/Network Services
	MIS/Operations
	Database Services
	Marketing
	Merchandising
	Fulfillment/Inventory Management
	Financial Management
	Executive
	E-Commerce/E-Business
	Other

V. TITLE *

Please indicate your title: (Choose only one)

	Chairman/CEO/President/COO
	EVP/SVP
	CIO
	CFO
	VP
	Director/Department Manager
	Other

* Required