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NYS Contract Participation Profile Form
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Contact Info
First Name:*
Last Name:*
Your E-Mail Address:*
Company Info
Your Title with the Company:*
Company Name:*
Your Account Number with Eaton's:
Company Address:*
Address 2:
City:*
State:*
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Zip Code:
County:
Office Phone Number:*
Office Fax Number:
Shipto Locations:
How many employees do you have:*
What is your Buying District:
Would you like a Catalog:
Yes
No
If Yes above how many Catalogs do you need:
What is your preferred method for the Price File
Hard Copy:
Yes
No
If you answered Yes how many do you need:
CD-Rom:
Yes
No
If you answered Yes how many CD's do you need:
E-Mail:
Yes
No
Which preferred methods of ordering would you like
Order by Phone:
Yes
No
Order by Mail:
Yes
No
Order by Internet:
Yes
No
Order by E-Mail:
Yes
No
Order by EDI:
Yes
No
Order by Fax:
Yes
No
Purchase Info
Do you use a Purchase Card:
Yes
No
Do you use a System Purchase Program:
Yes
No
If Yes what System Purchase Program do you use:
Which methods of Invoicing would you like
Invoices by Location:
Yes
No
Invoices by Cost Center:
Yes
No
Invoices by Departmental:
Yes
No
Invoices by Month:
Yes
No
Invoices Per Order:
Yes
No
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Can we contact you:
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