Chief Executive
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 ********** 3 DIG 200
#1234567 8# CEXA
MR JOHN SMITH
1101 CONNECTICUT AVE NW
WASHINGTON, DC 20036
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COMPANY ADDRESS:
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1.) Type of Business? (Check one category only):
01.Manufacturing
02.Bank/Bank Holding Company
03.Diversified Financial/Insurance
04.Energy/Utility
05.Communications
06.Construction/Engineering
07.Real Estate
08.Retail Trade
09.Management Service/Consulting Firm
10.Mining
11.Transportation
12.Wholesale Trade
13.Hotel
14.Agriculture
15.Holding Company
16.Government
17.Labor Union
18.Education/Religion
20.Technology-Hardware/Software/Data Services
21.Health Care
22.Services
23.Other Technology
99.Other (Please Specify):   
2.) What is your primary job title?
A.Chief Executive Officer
B.Chairman
C.President
D.Chief Operating Officer
E.Vice Chairman
F.Chief Financial Officer
G.Treasurer
H.Managing Director
J.Partner
K.CIO/CTO
Z.Other (Please Specify):
3.) Number of Employees (Check only one)
R.1 - 99
S.100 - 499
T.500 - 999
U.1000 - 4999
V.5000 - 9999
W.10,000 +
4.) Annual Gross Sales/Assets (Check only one)
8.$10 million - 19,999,999
7.$20 million - 24,999,999
2.$25 million - 49,999,999
3.$50 million - 99,999,999
4.$100 million - 249,999,999
1.$250 million - 499,999,999
5.$500 million - 999,999,999
6.$1 Billion +
5.) Type of Ownership (Check only one)
X.Publicly Traded   Y.Privately Held
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