Manufacturers Survey

Brickstores.com is your gateway to the flourishing Internet marketplace. We'll create an online catalog of your products and work closely with you to maximize your catalog's exposure through our expanding base of retail Web sites.

To get the ball rolling, please take a few minutes to complete the survey below.

1. Please provide us with your contact information.
(Fields with asterisks are required.)

* Contact Name:

* Title:

Company Name:

Address:
Street, City, State, Zip

Country:

* Phone:
ex: 617-555-1212

* Email:

URL:

2. Please describe your company's industry.

3. Please describe your product line(s).

4. Please indicate the approximate size of your company (annual gross revenue).
	$1 Million - $5 Million	$26 Million - $50 Million
	$6 Million - $15 Million	$51 Million - 100 Million
	$16 Million - $25 Million	More than $100 Million

5. How many retail accounts do you have?
	0 - 500	5,001 - 10,000
	501 - 1,000	10,001 - 15,000
	1,001 - 5000	More than 15,000

6. Please provide the names and phone numbers of some retailers who carry your line(s).

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Brickstores.com
35 Olympia Ave., Suite 2
Woburn, MA 01801
Phone: 1-888-462-6674 (462-6674)
Fax :781-935-4412
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