Newspaper

Is this a renewal order of your free subscription?

If you are renewing your free subscription and the information we have on file is correct, you do not need to fill out this form. Please visit our free subscription renewal form.

I want a FREE Subscription *

Renewal Yes No *

First Name *

Last Name *

Title *

Company Name *

Address *

Address Type Business Address Home Address *

Suite

PO Box (if applicable)

PO Zip Code

City *

County Allegan Barry Berrien Branch Calhoun Cass Ionia Kalamazoo Kent Mason Mecosta Montcalm Muskegon Newaygo Oceana Ottawa St. Joseph Van Buren *

State Michigan *

Zip Code *

Email *

Website

Phone *

Fax *

Year Company Est. *

Business publications audit requires the following data. Please complete the following information. All fields must be filled out to receive your FREE subscription:

Year of Birth *

How many people are employed at your company?

# of Employees Less than 10 Employees 10-49 Employees 50-99 Employees 100-249 Employees 250-499 Employees 500-999 Employees 1000 or more Employees

Industry/Profession Agriculture Banking/Finance Communications Construction/Contractors Education Government Insurance Legal Services Manufacturing Real Estate Retail Trade Services Transportation Utility Wholesale Other *

If you chose Mfg., Services or other, please specify type.

Mfg Type

Education - Please Select One Attended College College Graduate Post Grad Work Professional School Degree None of the Above *

Areas of purchasing influence - Please Select All That Apply

Influence Accounting Advertising/PR/Promotion Automobiles/Purchase/Lease Banking Building Materials/Equipment Computer/Technology Corporate Gifts Educational/Training Programs Health Benefits Legal Services Office Furniture Office Equipment/Supplies Telecommunications Equipment None of the above All of the above *

What is your company's annual sales volume?

Sales Under $500,000 $500,000-9.9 mill. $10 mill.-$25.9 mill. $26 mill.-$49.9 mill. $50 mill.-99.9 mill. $100 mill. + *

Sign up for MiBiz e-Newsletters: MiBiz Monday Morning
SmallBiz/Second Stage
West MI Manufacturing Report
West Michigan Nonprofit News

I give my permission to receive subscription renewals by fax from MiBiz or its fax service to the fax number I've provided on this form.

Permission To Fax for Renewal Yes No *

If you have any comments about MiBiz or news items/press releases regarding your company that you would like to submit for possible publication, please provide the information in the text box or fax press releases to 616-608-6182.

Notes