Part One

• Store Name
  
• Years in Business
  
• Address
  
• City
  
• State or Province
  
• Zip
  
• Contact
  
• Position
  
• Business Phone
  
• Fax
  
• E-Mail
  

Part Two

• How did you hear about us?
  An Ad:
  At Another Store At a Trade Show
• What type of store do you have?
  Select One Restaurant Catering Grocer Gourmet Foods Distributor Commercial Food Vendor
• What major products do you carry?
  
• What are your price points?
  Select One High End Moderate Price Low End
• What is your customer age range?
  Select 14-18 18-25 25-40 41-55 56-75+

Part Three

• Comments or Questions