1.	Do you wish to receive a FREE subscription to Collections & Credit Risk?

Yes     No

First Name:
Last Name:
Job Title:
Company Name:
	(Please provide your Company Name in full: abbreviations could disqualify you)
Street Address:
Dept/Div.:
City:
State:	Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming   American Samoa Guam Marshall Islands Micronesia (Federated States of) Palau Puerto Rico U.S. Minor Outlying Islands U.S. Virgin Islands Northern Mariana Islands Armed Forces Americas AA Armed Forces Middle East, Europe, Canada AE Armed Forces Pacific AP   Other
Zip:
Country:	UNITED STATES OTHER
	(Note: If your country is not listed above, subscriptions are not currently available at your location.)
Phone:
Fax:
Email:
	(Note: Valid email address is required or you could be disqualified.)

YES, I am interested in receiving information via email from third party industry solution providers. I understand that I can opt-out at any time in accordance with Collections & Credit Risk's privacy commitment.

What is the approximate number of employees in your company? (select only one)

Select Number of Employees Less than 50 50-99 100-499 500-999 1,000-4,999 5,000-9,999 Greater than 10,000

Yes, please auto-fill my contact information for other publication qualification forms.

2.	Please check your title: (select only one)

President/CEO/Chairman	Collections Manager or Director
CFO/ Treasurer/Controller	Analyst, Researcher
EVP/SVP/VP/CIO/Managing Director	Accountant
Attorney/Law Partner	Other (please specify)
Credit Manager or Director

3.	Please select the category which best describes your industry: (select only one)

Bank	Student Lender
S&L	Healthcare
Credit Union	Insurance
Credit Card Co.	Telecommunications
Mortgage Co.	Utility (Electric, Gas, Water)
Auto Finance Co.	Collections Agency
Finance Co.	Law Firm
Leasing Co.	Bankruptcy Recovery/Services
Manufacturer	Debt Buyer/Seller/Broker
Wholesaler	Industrial (non-mfg., please specify)
Retailer	Other (please specify)
Service Co.
Government (non-student)

4.	Please select your primary area type of business: (select only one)

Consumer Credit or Collections	Vendor (please specify)
Commercial Credit or Collections	Other (please specify)
Both

5.	Do you recommend, specify, or buy the following: (select only one)

Account Receivable Management Services	Electronic Bill Presentment/Payment/Checks
Advertising/Marketing Services	Electronic Directory Assistance
Attorney Services	Executive Recruitment
Automated/Predictive Dialing Systems	Fraud Control Systems/Services
Call Center Systems/Services	Internet/E-Commerce Services
Computer Hardware/Systems	Mail Services
Credit Information	Scoring Information/Services
Credit Insurance	Skip Tracing/Asset Location Services
Credit Risk Management Services	Software (please specify)
Debt Collection Services	Training Education
Debt Portfolios

6.	For verification purposes, please select the month in which you were born:

Select month born January February March April May June July August September October November December

7.	Do you want to receive CCRNewsline, a FREE weekly email newsletter?

Yes     No

8.	Do you want to receive CCR HealthLine, a FREE weekly email newsletter?

Yes     No

Would you like to receive EMAIL notices of other print or online publications, and other relevant offers from TradePub.com?

Yes     No

Sign up for special offer alerts from select partners featuring the latest products and services you are interested in.

Yes     No

The Total Economic Impact™ of eStara Click to Call: In this report, Forrester Research conducted in-depth analysis of multiple implementations of eStara Click to Call. The financial analysis in this study illustrates a way to evaluate the value of Click to Call: proven ROI a payback period of between seven and 14 months an improvement in the conversion rate for leads generated by Click to Call Written by Forrester Consulting, Hosted by eStara Connections from ATG Note: Offer Valid in the United States and Canada Only.

Abacus is the accountant-centric magazine focused on small to mid-size accounting practice firms that provides stimulating and provocative articles from a perspective you won't find in any trade magazine. Read insightful case studies of how real accountants are solving real world problems using innovative solutions and techniques. Find practical tips to advance your practice. Subscription to Abacus also entitles you to a FREE life membership of AccountantsWorld.com that gives accountants access to multiple tools and resources that will enhance their practices and allow them to make more money. Note: Offer Valid in the United States Only.

Request your free Report: Using Talent Supply Chain Management to Overcome Challenges in the Professional Services Market. Learn key processes within talent supply chain management and see how small improvements to those processes can significantly affect the overall performance of an organization. Discover how implementing an integrated talent supply chain management environment can help professional services providers enhance revenues by improving delivery performance and speeding client response. Learn how you can improve talent productivity at lower costs and improve service. Note: Offer Valid in the United States and Canada Only.

Request Your Free Guide: Meeting Vulnerability Scanning Requirements for PCI. Learn the scanning requirements for PCI-DSS to achieve compliance. The credit card industry is stepping up efforts to strengthen cardholder data security by raising member validation requirements for compliance with the Payment Card Industry Data Security Standard (PCI-DSS). As part of these requirements, both internal and external network scanning play a critical role in achieving compliance. This security guide describes the scanning requirements for PCI-DSS and provides a quick-reference requirements matrix for both Merchants and Service Providers of all levels. Note: Offer Valid in the United States and Canada Only.

What is the approximate number of employees in your company? (select only one)

Select Number of Employees Less than 50 50-99 100-499 500-999 1,000-4,999 5,000-9,999 Greater than 10,000

What is your job title? (select only one)

Select your job title Chief Executive Officer Chief Information Officer Chief Security Officer Chief Technology Officer Chief Information Security Officer Vice President IT (Director / Manager) Network Security Manager Network Systems Administrator Network Systems Engineer Systems Engineering Other (please specify)

Please specify for Other:

What best describes your network? (select only one)

Select what best describes your network Home Network Small/Medium Business (up to 2,000 IPs) Large Enterprise (2,000+ IPs) Consulting Organization

When are you looking to implement a vulnerability management solution? (select only one)

Select timeframe Immediately Within 3 months 3 to 6 months 6 to 9 months 9+ months

---

Security Check: Enter both words below, separated by a space.