| Company Name: ____________________________________ |
| Location(s) Reported: ____________________________________ |
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| Contact Regarding Data Submittal: |
Name and Address for Survey Results: |
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| Name: |
_______________________ |
| Title: |
_______________________ |
| Phone Number: |
_______________________ |
| Fax Number: |
_______________________ |
| E-mail: |
_______________________ |
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| Name: |
_______________________ |
| Title: |
_______________________ |
| Address: |
_______________________ |
| |
_______________________ |
| E-mail: |
_______________________ |
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| Company Information: |
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| Type of Business: |
_______________________ |
| Annual Sales Volume: |
_______________________ |
| Number of Employees: |
_______________________ |
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| Annual Revenue:: |
_______________________ |
| Total Asset Size: |
_______________________ |
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| Are your employees represented by an Union?
[ ] No [ ]
Yes |
| If yes,
how many employees are represented by an union? ________________ |
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