Donor Information: *Donor Name: Title: *Organization: *Street Address 1: Street Address 2: *City: *State: Select One AB AK AL AR AZ BC CA CO CT DC DE FL GA HI IA ID IL IN KA KS KY LA LB MA MB MD ME MI MN MO MS MT NB NC ND NE NF NH NJ NM NS NT NV NY OH OK ON OR PA PE PQ RI SC SD SK TN TX UT VA VT WA WI WV WY YT *Zip Code: *Contact Phone: Contact Fax: *Your Email: Referred By: Direct Mail Package Referred by another organization Magazine Article Magazine Ad Internet Search Unknown If you read about NAEIR in a newspaper, newsletter, or magazine, please provide the name of the publication in the "Comments" box below. If you are responding from a direct mail piece that you received, we would appreciate knowing the eight character code, located on the response coupon. Please provide this code in the "Comments" box below. Type of company: Manufacturer Wholesaler Retailer Other Fiscal Year End: January February March April May June July August September October November December Primary SIC Code: Corporation Type: Regular "C" Corporation Sole Proprietorship or Partnership "S" Corporation What products do you carry? (check all that apply) Educational Computer Maintenance Building Supplies Children's Items/Toys Household Goods Clothing Paper Products Office Supplies Health and Beauty Sporting Goods Arts and Crafts Comments:
