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  • First Name*
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  • Last Name*
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  • Title*
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  • Company*
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  • Address 1*Street Address
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  • Address 2*Apt, Unit, Suite, etc.
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  • City*
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  • Mother's Maiden Name*
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  • Business Details
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  • Your organization's annual sales volume in $Millions*
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  • Our company markets in*check all that apply
    Canada
    United States
    Internationally
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  • I am involved with*check all that apply
    Consumer Direct Marketing
    B 2 B Direct Marketing
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  • Business Type
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  • Job Function
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  • Please indicate one primary job function and as many secondary job functions as apply:*PrimarySecondaryNot Applicable
    Corporate General Management
    Marketing
    Loyalty/Relationship/Customer Retention
    Finance
    Treasury
    Sales/Business Development
    Customer Service/Consumer Affairs/Customer Support/Privacy
    IT
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  • I Approve
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    Payments Processor
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    Association Membership
    Technology
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    Market Research
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    Distribution Services
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  • Please send more Info*Regarding
    Advertising in Payments Business
    Advertising on the PB Website
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    In Person Events or Sponsorship
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  • Payments Details*
    Bill Me
    I'm mailing a cheque
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  • Purchase Order #*
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  • Make cheque out to Lloydmedia, Inc. and mail to: 302-137 Main Street North Markham, ON L3P 1Y2
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