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2. To permit future verification of your request, please answer ONE of the following questions: (select only one)
What is your middle name? OR
How many sisters do you have?


3. Which of the following best describes your business? (select only one)
Retailer: Department/Variety Store (e.g. Macy's, Federated, Selfridges, Marks and Spencer) Advertising/Marketing/Promotions/ Design Agency
Retailer: Direct Mail/Catalog/ Mail Order Licensee/Manufacturer
Retailer: Discount Store/Mass Merchant/ Cash & Carry (e.g. Target, Kmart, Costco) Licensing Agent/Consultant
Retailer: Drug Store/Pharmacy (e.g. Boots, CVS, Walgreens) Licensor/Brand Owner/Property Owner
Retailer: Grocery / Supermarket (e.g. Albertsons, Safeway, Tesco) Wholesaler/Distributor/Importer
Retailer: Specialty Store (specializes in a specific range of merchandise and related items - e.g. Bed, Bath & Beyond, Circuit City, Gap, Hot Topic, Toys 'R' US) Professional Services (including Accountancy & Legal services)
Retailer: Online/TV Shopping Other (please specify)
Retailer: Other (please specify)


4. Which best describes your title? (select only one)
Owner/CEO/President/ Managing Director Marketing Manager/Director
Vice President/General Manager Licensing Manager/Director
Buyer/Assistant Buyer Product Development Manager/Director
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Creative/Design Manager/Director Other (please specify)
Business Development/Sales


5. What is your role in licensing decisions: (select only one)
Final     Recommend/Initiate     No Authority


6. MANUFACTURERS/LICENSEES/DISTRIBUTORS: Indicate which products your company makes. RETAILERS: Indicate which products your company buys/merchandises. LICENSORS: Indicate the product categories in which your company has or seeks licensing activities. (select all that apply)
Art & Design Jewelry/Watches
Apparel/Fashion/Accessories Pet Products
Automotive Private Label
Consumer Electronics/Computer Hardware Promotions/Incentives
DVD/TV/Film Publishing
Food/Beverages Sporting Goods/Outdoor
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