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Type of Request:*BusinessIndividual

Language:* English

First Name:*

Last Name:*

Title:

Company Name:*

Address (No PO Box):*

Address Line 2:

City:*

State:*AlabamaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code:*Last four digits of zip code are optional.

Country:United States of America

Phone Number:

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Fax Number:

Email Address:

Company Size:*Please select... 1 2-7 8-19 20-49 50-100 100+

Business Type:*Please select...AccountingAdvertising MarketingAgricultural ServicesArchitectAuto/Repair/LeaseBanking/FinanceBusiness ServicesCommunicationsConstructionEducationEngineerFarmingFish/Hunt/TrapForestryGovernmentHotels/MotelsIndependent ProfessionalInsuranceLegalManagement ServicesManufacturingMedicalMiningMotion PicturesNon ProfitPersonal ServicesPrinting PublishingReal EstateRecreationRestaurant/BarRetailerSocial ServicesTransportUnknownUtilitiesWholesalerOther

Where have you shopped?Please select...Staples StoreCatalog/Delivery ServiceBothNever Shopped Staples Before

How did you first hear about Staples?Please select...Existing CustomerFriend/ColleagueInternetMagazineMail In Card or Other CardNewspapers/Circulars/FlyersRadio/TVSales RepSaw/Visited a StoreStaples MailingOther/UnknownYellow Pages

Would you like to be contacted by a Staples sales representative?NoYes