Free
Listing
Form

 Lippincott Williams & Wilkins
333 Seventh Avenue, 19th Floor
New York, NY 10001
Phone: 646/674-6544
Fax: 646/674-6500
To list your company in the World Directory 2008, please complete this FREE Listing form.

YOUR INFORMATION MUST BE RECEIVED BY SEPTEMBER 8th.

CORPORATE INFORMATION: Please provide your company name, address, phone/fax in the space below, exactly as you wish it to appear in the World Directory 2008 edition. If you are a subsidiary/division, please list the name that takes precedence first. The Mailing Contact is the person to receive this form for next year’s World Directory.
Please complete this form with all requested information. This form MUST be signed and returned to receive your company's FREE LISTINGS in the WORLD DIRECTORY 2008.

Name______________________________

Title_______________________________

Date_______________________________
Signature___________________________


Company Name: ___________________________________________________

Address:___________________________________________________

City, State, Zip:___________________________________________________

Country:___________________________________________________

Corporate Telephone: (include area/county code)______________________

Fax:___________________________________________________

E-mail:___________________________________________________

World Wide Web:___________________________________________________

Mailing Contact:___________________________________________________


Check/Correct below to indicate the PRIMARY FUNCTION(s) of your company:
Manufacturer
Distributor 		Repair/Laboratory/Services Publisher/Publications Association/Organization
Servicese.g. Insurance, Marketing, Computer Programs

Provide the Name and Title(s) of up to 4 (four) KEY INSIDE CONTACTS within your company:
_______________________________
_______________________________ 		_______________________________
_______________________________

DESCRIPTION: Provide a brief description of your company's products and/or capabilities.
_______________________________
_______________________________ 		_______________________________
_______________________________

TRADE/BRAND NAME LISTINGS: Provide the name only of up to ten of your Trade or Brand Names.
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________ 		_______________________________
_______________________________
_______________________________
_______________________________
_______________________________

DISTRIBUTOR: If your company is primarily a distributor, please provide the name of the company(s) whose products you distribute on a separate sheet of paper.

FREE PRODUCT LISTINGS: Please review the enclosed Product Category List to add the code and description of any product(s) your
company manufactures or supplies in the space provided below.

Code Description




Please log on to http://www.e-circ.net/hj and update your listing… OR
Fax your signed form to 646/674-6500 immediately.
Please type or print legibly. We cannot be responsible for illegible entries.