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Are you involved in the site selection, corporate facility planning or real estate decisions at your company? Yes No
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Company
Name	First Last
Business Title
Address 1
Address 2
City
State/Province
Zip or Postal Code
Nation
Phone
Fax
Email
Web Address
Type of Firm	Manufacturing Service
Primary Product or Service
Total Number of Employees in Your Company	1000+ 500-999 100-499 50-99 20-49 1-19
If Yes, Please Indicate Type of Involvement: Primary Decision Maker Member of Project Team Other* *If Other, Describe:
Are you currently involved in an active site search? Yes No
Does your company have any relocation or expansion needs? Yes No
In order to process this request (for audit verification purposes), What is the day you were born (ex. 25)?:

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