THE MALL AT FAIRFIELD COMMONS MERCHANT MANUAL
TABLE OF CONTENTS
THE MALL AT FAIRFIELD COMMONS MISSION STATEMENT…..…..4
GENERAL INFORMATION
Management Information…………………………………………….………………………………..5
Who’s Who in the Management Office...... 5-6
Important Phone Numbers...... 7
Hours of Operation...... 7
Center Fact Sheet...... 8
Center Amenities...... 9
Guest Services...... 10
Directions to Mall at Fairfield Commons...... 10-11
Merchants Listing...... 12
Local Resources for Merchants...... 13-14
Area Hotels...... 15
Specialty Leasing Program…………………………………………………………………….……….15
OPERATIONS & MAINTENANCE
Emergency Contact Information...... 16
Employee Parking Guidelines...... 17
Store Maintenance & Inspections...... 17
Pest Control...... 17
Vendors……………………………………………………………………….…………………………….. 18
Waste Management Features & Benefits...... 18
Waste Management Procedures...... 19-20
Waste Management Guidelines & Rules...... 20
Waste Management Customer Contact Information...... 20-21
Procedures for New and Temporary Tenants...... 21
Special Waste & Additional Services...... 21-22
Merchant Waste Management Responsibilities...... 22
Roof Access...... 23
Roof Leaks...... 23
Heating & Air Conditioning...... 23
Construction & Remodeling…………………………………………………………………………..23-24
Deliveries...... 24
Store Mailboxes...... 24
Signage & Display Guidelines...... 24-25
Housekeeping...... 25
Food Court Trays...... 25
No Smoking Policy...... 25
MALL SECURITY
Security at Mall at Fairfield Commons...... 26
To Request Immediate Assistance...... 26
Police Substation...... 26
Policy on Merchant Assistance...... 27
Use of the Duress Code...... 27
Disorderly Customer...... 27
Accidents...... 28
Solicitors...... 28
Medical Emergency...... 28
Lost Children/Lost Parent...... 28
Lost & Found...... 28
Auto Assistance...... 28
Travelers Checks...... 29
After Hours Access Procedures...... 29-30
Internal Security...... 30
General Security Tips...... 30
Tips on Spotting a Shoplifter…………………………………………………………………….…....30
Emergency Situations...... 31
Robbery...... 31
Breaking & Entering...... 31
Bomb Threat...... 31
Bomb Threat Checklist……………………………………………………………………………..32
Fire...... 33
Electrical Failure...... 34
Leaking Sprinkler Head...... 34
Mall Security Rules & Regulations...... 34-36
Overnight Parking / Towing Policy………………………………………………………………….36-37
MARKETING
Demographic Summary...... 38
Marketing Tools for Success...... 39
Sign Holders...... 39
Table Tent Cards...... 39
Display Cases ………………………………………………………………………………………….39
Red Folder Program...... 39
Momtopia...... 40
Shopping Line………………………………………………………………………..………………..40
License to Shop….……………………………………………………..…………………………….40
Website...... 40
E-Mail Marketing…………………………...... 41
Employee Discounts………………………………………………………………….………..41
Store Directory……………………………………………………..…………………….…….41
Facility Availability…………………..…..…………………………………………………………..41
People Counter.…………………………………………………..…………………………….42
Gift Cards...... 41-43
Merchant Media Response Procedures...... 43
Tourism at Mall at Fairfield Commons...... 44
Policy on Customer Comment Cards…………………………………………....…………..……45
MAGICAL NIGHT OF GIVING
What is Magical Night of Giving ………………………………….…………………………………45
Who is Involved?...... 45
Magical Night of Giving is a Winning Situation for All ………………..……………..……..45
How Merchants Can Participate …………………………………………………………..………..46
Magical Night of Giving Contact Information …………………………………………………..46
SERVICE AT EVERY LEVEL
Introduction...... 47
The Mall at Fairfield Commons Culture and Values...... 47
Service Definitions...... 48
Service Facts...... 49
First Impressions...... 49
Communication...... 50-52
The Mall at Fairfield Commons Lingo...... 53
What to Say Instead of No...... 53
Description of “Service At Every Level”...... 54-55
Keep Your Eyes Open...... 55-56
The Thirty Second Rule...... 56
How to Assist a Dissatisfied Guest...... 56-58
Ten Good Service Habits...... 59-60
“Service At Every Level” Ideals...... 60
The Rewards of “Service At Every Level”…………………………………………………………61
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THE MALL AT FAIRFIELD COMMONS MERCHANT MANUAL
GENERAL INFORMATION
THE MALL AT FAIRFIELD COMMONS
MISSION STATEMENT
The Mission of The Mall at Fairfield Commons is to provide our guests with a comfortable shopping experience. By comfortable we mean to provide the highest level of cleanliness, security, and friendliness to our guests, tenants, as well as to each other. We are in the business of satisfying our guests’ needs while making their stay at our property a memorable experience.
MANAGEMENT INFORMATION
The Mall at Fairfield Commons is owned and managed by Glimcher Properties Limited Trust, which is based in Columbus, Ohio.
Glimcher currently owns and manages over 20 regional malls, 3 value mega malls and numerous community center properties.
WHO’S WHO IN THE MANAGEMENT OFFICE
LOCATION:Lower Level, west side, near Sears, Entrance C
HOURS:Monday – Friday, 8:30 am – 5:30 pm
“Manager On Duty” available daily 5:30 PM - Close
Address:The Mall at Fairfield Commons
Management Office
2727 Fairfield Commons
Beavercreek, Ohio45431
Telephone:(937) 427-4300
FAX:(937) 427-3668
General Manager: ..………………………………………………...Dave Duebber
Responsible for all aspects of operations and administration of the shopping center. As the leader of the Mall Management Team, the General Manager interacts with the center merchants, local government agencies, local businesses, and customers.
Operations Director:…………………………………...…………….Jerry Pauley
Responsible for all operational issues including center maintenance, landscaping, housekeeping, security, and tenant construction activity.
Maintenance Supervisor: ...………………………………..…...…Bob Forinash
Responsible for assisting Operations Director with all operational issues including center maintenance, landscaping, and tenant construction activity.
Marketing Director:…………………………………….……………Kristie Miller
Leads overall marketing efforts for center, including advertising, public relations, retailer communication, special events, sponsorships, customer service and accountable for administration of marketing fund.
Marketing Coordinator:……..………………………………………Kristin Stroh
Assists Marketing Director in all aspects of marketing of The Mall at Fairfield Commons, with specific responsibility for special events, web site, merchant relations, and Guest Services.
Specialty Leasing Manager: ..………………………………..…Connie Nichols
Specialty Leasing Coordinator: ...………………………………Jennifer Green
Directs the leasing of temporary space throughout the center. This includes retail merchandising units, kiosks, and temporary in-line space.
Security Director: ……………………………………………...……Korrina Miller
Responsible for direct supervision of all aspects of mall security for both the interior and exterior of the property.
Housekeeping Supervisor: ..………………………………………..Stan Parrott
Responsible for direct supervision of all aspects of housekeeping for the center including the common areas and food court.
Administrative Assistant:………………………………….Heather Guisinger
Responsible for administrative functions of the management office.
Guest Services Coordinator: ………………………………Leighann GodboltResponsible for overseeing the operation of the GuestServiceCenter.
Receptionist:……………………………………………………...Natalie Ehrhart
Responsible for assisting the Administrative Assistant with all functions of the Mall Management Office.
IMPORTANT PHONE NUMBERS
For all emergencies...... 911
Beavercreek Police Department……………………………………………… (937) 426-1225
BeavercreekFire Department………………………………………………….(937) 426-1211
Rescue Squad...... 911
The Mall at Fairfield Commons Management Office……………………(937) 427-9031
The Mall at Fairfield Commons Public Safety……………………………..(937) 427-9170
Guest Services……………………………………………………………………….(937) 427-4300
State Police……………………………………………………………………………(937) 372-7671
Dept. of Health………………………………………………………………………(937) 285-6250
GreeneCounty Water Supply & Treatment………………………………..(937) 429-0127
Dayton Power & Light…………………………………………..(937) 224-6000 or 331-3000
Ameritech Phone Co……………………………………………………………….(800) 660-3000
Beavercreek Engineering & Inspection………………………………………(937) 427-5513
Beavercreek Planning & Zoning………………………………………………..(937) 427-5512
BeavercreekCity Offices, 1368 Research Drive………………………….(937) 426-5100
HOURS OF OPERATION
Management will enforce hours of operation as specified in your lease.
Normal operating hours for tenants are:
Monday-Saturday 10:00 am – 9:00 pm
Sunday 12:00 pm – 6:00 pm
These hours may vary on holidays. Whenever changes do occur, Mall Management will notify you in writing. Your store is expected to be open during all hours of operation.
Normal business hours for the Management Office are: 8:30 am – 5:30 pm.
A representative of the Mall Management Team or the “Manger on Duty” will be on site during all hours of operation.
CENTER FACT SHEET
YEAR OPENED
/ 1993LOCATION / Beavercreek, Greene County, Ohio
MAILING ADDRESS / The Mall at Fairfield Commons
2727 Fairfield Commons
Beavercreek, Ohio45431
OWNER / Glimcher Realty Trust
ARCHITECT / Keeva J. Kekst
REGIONAL ACCESS / I-675 Provides Access to I-70, I-75,and Route 35
GLA / 1,012,534 square feet
ANCHORS / Elder-Beerman Men’s, Home and Furniture, Elder-Beerman For Her, JCPenney, Macy’s, Dick’s Sporting Goods and
Sears
STORES / Over 150
RESTAURANTS / Don Pablos, Max & Erma’s, Panera Bread, Red Robin and Fox & Hound
FOOD COURT / 650 seats
ENTRANCES
Total
Into common area
Into retail stores / 18
6
12
TRADE AREA POPULATION / 892,491
TRAFFIC / Over 8.5 million visitors per year
EMPLOYMENT AT CENTER / 2,500 employees
MEDIAN AGE / 37.7
AVERAGE HOUSEHOLD INCOME:
For Trade Area
For Beavercreek Area / $51,414.00
$68,800.00
*Demographic Information is based on the 2000 census.*
CENTER AMENITIES
As employees of stores at The Mall at Fairfield Commons, you are also ambassadors for The Mall at Fairfield Commons. Many of you will come in contact with shoppers who are unable to locate various necessities. Please be familiar with the following center amenities:
ATMs
/ Lower Level, near Guest ServicesLower Level, near Elder-Beerman, next to escalator
Upper Level, near Food Court, by Mall Entrance D Doors
Restrooms / Upper Level, near Food Court
Family restrooms / Upper Level, near Food Court
Changing Stations / In all restrooms
Elevators / Center Court and in all Anchor stores
Fax service, Copy Service, and Postage Stamps / At Guest Services, Lower Level, base of Grand Staircase.
All services performed for a fee.
Strollers and Wheel Chairs / At Guest Services, Lower Level, base of Grand Staircase.
Guest Services / Lower Level, base of Grand Staircase
Food COURT / Upper Level, North Side, Near Center Court
Restaurants / California Pizza Kitchen, Don Pablos, The Hops, Max & Erma’s, Red Robin and Panera Bread
Telephones / In all Common Area Entrances and Near Restrooms
TDD TeLEPHONES
(Hearing Impaired) / At Guest Services, Lower Level, base of Grand Staircase
Water Fountains / Near Public Restrooms
MOTORCOACH PARKING / South West Parking Lot, near Sears
MAILROOM / Upper Level, North side, Near Food Court
NIGHT DEPOSIT FOR MERCHANTS
There is a night deposit facility operated by Chase. It is located on the Upper Level, near Food Court, next to the Mall Entrance.
If you would like more information on the night deposit, please call your bank or Bank One.
GUEST SERVICES
Guest Services will serve as the focal point for all center programs. All Guest Services personnel will embrace the belief in “Service at Every Level”, making certain to go above and beyond what is necessary to guarantee each guest’s trip to The Mall at Fairfield Commons is a positively memorable experience.
Location:Lower Level, at the base of the Grand Staircase
GUEST SERVICES / PHONE NUMBERLower Level / (937) 427 – 4301
Hours: All hours of center operation
AmenitiesServices:
Brochure Displays
Directions
Employment Opportunities
Fashion Forum Registration
First Aid
Gift Cards
Hotel/Motel Information
Lost & Found
Mall Walkers Information
Momtopia Registration
Public Safety Assistance
Store Directories
Stroller Rental
Taxi Services
Wheelchairs
DIRECTIONS TO THE MALL AT FAIRFIELD COMMONS
FROM THE SOUTH
Interstate 75 North to Interstate 675 North to Exit 17 North (North Fairfield Road). Turn right, ½ mile on the right.
FROM THE DAYTON MALL AREA
(CENTERVILLE, MIAMISBURG)
Interstate 675 North to Exit 17 (North Fairfield Road). Turn right, ½ mile on the right.
FROM INDIANA OR WEST OF DAYTON ON INTERSTATE 70
(RICHMOND, BROOKVILLE, CLAYTON)
Interstate 70 East to Interstate 675 South to Exit 17 (North Fairfield Road). Turn left, ½ mile on the right.
FROM THE AIRPORT
(ENGLEWOOD, VANDALIA, HUBER HEIGHTS)
Interstate 70 East to Interstate 675 South to Exit 17 (North Fairfield Road). Turn left, ½ mile on the right.
FROM DOWNTOWN
State Route 35 East to Interstate 675 North to Exit 17 (North Fairfield Road). Turn right, ½ mile on the right.
FROM EAST OF DAYTON
(XENIA, JAMESTOWN, WASHINGTON COURT HOUSE)
State Route 35 West to North Fairfield Road. Turn right, 4 miles on the left.
FROM EAST OF DAYTON
(SPRINGFIELD, COLUMBUS, LONDON)
Interstate 70 West to Interstate 675 South to Exit 17 (North Fairfield Road). Turn left, ½ mile on the right.
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THE MALL AT FAIRFIELD COMMONS MERCHANT MANUAL
GENERAL INFORMATION
Merchant Listing
Abercrombie (Kids)
Abercrombie & Fitch
Aeropostale
Aldo
American Eagle Outfitters
American Greetings
Ann Taylor
Ashcroft & Oak
Bath and Body Works
Bath and Body at Home
Body Central
Brookstone
The Buckeye Room
Build-A-Bear Workshop
The Buckle
Cajun Ming
Cardboard Heroes
Casual Corner
Champs
Charlotte Russe
Chick-Fil-A
Christopher & Banks
Club Libby Lu
The Children’s Place
CincinnatiBell Wireless
Claire’s Boutique
Dakota Watch Company
Dell Direct
Designer’s Nails
Easy Spirit
Elder-Beerman For Her
Elder-Beerman Men’s, Kids,
Home and Furniture
Express
Express Men
Fetch
The Finish Line
Flamingos
Foot Locker
Franklin Covey
Fredrick’s of Hollywood
FYE
The Gap
Gap Kids / Baby Gap
GameStop
GNC
Godiva Chocolatier
Gold Star Chili
Great American Cookie Co.
Great Steak and Potato Co.
Gymboree
Hollister
Hot Topic
The Icing
JCPenney
Journey’s
Journeys Kidz
Kay Jewelers
Kirlin’s Hallmark
Lady Foot Locker
Lane Bryant
LensCrafters
Lids
The Limited
Limited Too
Macy’s
Mastercuts
Motherhood Maternity
MW Tux
New York and Company
90’s Nails
Nirvana
Occasionally Yours
The Olde Farmstead
Osterman Jewelers
PacSun
Payless Shoe Source
Popcorn Pizzazz/Pretzel Fest
Radio Shack
Regis Hairstylists
Rocky Mountain Choc.
Factory
Rogers Jewelers
Sbarro’s
Sarku Japan
Sears
SHE Fashions
The Shoe Department
Skeffington’s Formal Wear
Spencers Gifts
Starbucks
Star Wok
Subway
Suncoast Motion Picture Co.
Sunglass Hut
T-Mobile
Things Remembered
Trade Secret
Tradehome Shoes
Victoria’s Secret
Vitamin World
Waggoner Chocolatier
WaldenBooks, WaldenKids
The Walking Place
Wet Seal
The White Barn Candle Co.
Williams- Sonoma
Yankee Candle Co.
Zales
OUTPARCELS
Chase
Courtyard by Marriott
Don Pablos
The Fox & Hound
Jared
Marriott Residence Inn
Max & Erma’s
National City Bank
Panera Bread
Red Robin
Regal Cinemas
Verizon Wireless
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LOCAL RESOURCES FOR MERCHANTS
BANKS
Chase / 2761 Fairfield Commons / Beavercreek / 937-443-6205Fifth Third / 3600 Dayton Xenia Rd / Beavercreek / 937-426-7025
Fifth Third / 1911 Old Fairfield Rd. / Beavercreek / 937-320-5300
Fifth Third / 240 E. Dayton Yellow Springs Rd. / Fairborn / 937-879-3358
Huntington Bank / 2374 Lakeview Dr. / Beavercreek / 937-427-3715
Key Bank / 3294 Kemp Rd. / Beavercreek / 937-426-3846
Key Bank / 1360 N. Fairfield Rd. / Beavercreek / 937-426-5346
Liberty Savings / 3210 Seajay Dr. / Beavercreek / 937-426-4925
National City Bank / 2761 Fairfield Commons / Beavercreek / 937-429-8840
National City Bank / 3160 DaytonXenia / Beavercreek / 937-426-7976
US Bank / 3822 Colonel Glenn Hwy. / Fairborn / 937-426-6700
US Bank / 3245 Dayton-Xenia / Beavercreek / 937-320-5020
TAXI/CAR SERVICES
Yellow Cab / 700 E. 4th St. / Dayton / 937-228-1155
AirCitySkyline Cab / 1340 Linden Ave. / Dayton / 937-254-1100
Diamond Cab Company / 3008 Dixie Dr. / Dayton / 937-277-1000
Alamo Rental Car / 888-426-3296
Apex Rent A Car / 3301 E. Patterson Rd. / Dayton / 937-429-3316
Avis Rent A Car / 644 N. Broad St. / Fairborn / 937-873-9818
Budget Car/Truck Rental / 3851 Dayton-Xenia Rd. / Dayton / 937-431-8408
Enterprise / 125 N. Broad St. / Fairborn / 937-879-0023
PRINTING SERVICES
Corner Copy Shop / 3783 Dayton Xenia Rd / Beavercreek / 937-429-3823
Domicone Printing Co. / 854 Kauffman Ave. / Fairborn / 937-878-3080
FedEx Kinko’s / 2646 Colonel Glenn Hwy / Beavercreek / 937-429-2585
Hadley Printing / 1530 Marsetta Dr. / Dayton / 937-426-0952
Office Max / 2750 N. Fairfield Rd. / Beavercreek / 937-320-0146
The UPS Store / 3195 Dayton Xenia Rd #900 / Beavercreek / 937-431-1882
GAS STATIONS
BeavercreekMarathon / 3844 Dayton Xenia Rd. / Beavercreek / 937-426-3951
Beavercreek Sunoco / 1326 N. Fairfield Rd. / Beavercreek / 937-429-1127
BP Oil Co. / 2835 N. Fairfield Rd. / Beavercreek / 937-429-9901
Speedway / 2254 N. Fairfield Rd. / Beavercreek / 937-429-9720
Speedway / 2570 Colonel Glenn Hwy / Fairborn / 937-427-2063
Speedway / 179 E. Dayton Yellow Springs Rd / Fairborn / 937-879-1870
RA Corp / 3887 Colonel Glenn Hwy. / Fairborn / 937-320-1791
HARDWARE/HOME STORES
Handyman Ace Hardware / 122 E. Dayton Yellow Springs Rd / Fairborn / 937-879-7866
Home Depot / 3775 Presidential Dr. / Fairborn / 937-431-7346
Lowe’s / 2850 Center Dr. / Beavercreek / 937-427-1110
DRUG STORES
CVS / 200 E. Dayton Yellow Springs Rd. / Fairborn / 937-878-3991
CVS / 1331 N. Fairfield Rd. / Beavercreek / 937-426-4478
Krogers / 3195 Dayton-Xenia / Beavercreek / 937-429-4707
Meijer / 3822 Colonel Glen Hwy / Fairborn / 937-426-3600
Target / 2490 N. Fairfield Rd. / Beavercreek / 937-431-8600
Walgreens / 183 E. Dayton Yellow Springs Rd. / Fairborn / 937-878-2889
Wal-Mart / 3360 New Germany-Trebein Rd. / Beavercreek / 937-426-7007
SUPPLIES
Ikon Office Solutions Inc / 1106 Kauffman Ave. / Fairborn / 937-879-9850
Office Depot / 2850 Centre Dr. / Beavercreek / 937-320-1334
Staples Office Supply / 6254 Wilmington Pike / Dayton / 937-848-6917
MAIL SERVICES
Beavercreek Post Office / 3541 Dayton-Xenia Rd. / Beavercreek / 937-426-6644
Fairborn Post Office / 67 W. Hebble Ave. / Beavercreek / 937-878-4648
FedEx Kinko’s / 2646 Colonel Glenn Hwy / Beavercreek / 937-429-2585
The UPS Store / 3195 Dayton Xenia Rd #900 / Beavercreek / 937-431-1882
FLORISTS
Beavercreek Florist / 2173 N. Fairfield Rd. / Beavercreek / 937-426-4253
Fairborn Florist / 1876 S. Maple Ave. / Fairborn / 937-879-1800
Knollwood / 3766 Dayton-Xenia Rd. / Beavercreek / 937-426-0861
DRY CLEANERS
Capitol Dry Cleaners / 3798 Dayton Xenia Rd / Dayton / 937-426-7111
Fine Cleaners / 1285 N. Fairfield Rd. / Beavercreek / 937-431-1338
HOSPITALS
Children’s Medical Center / One Children’s Plaza / Dayton / 937-641-3000
Greene Memorial Hosp / 3359 Kemp Rd. / Beavercreek / 937-458-4500
GMH Urgent Care / 3371 Kemp Rd. / Beavercreek / 937-458-4200
KetteringMedicalCenter / 3535 Southern. Blvd / Kettering / 937-298-4331
MiamiValleyHospital / One Wyoming Street / Dayton / 937-208-8000
Southview / 1997 Miami-Center Rd. / Dayton / 937-439-6000
AREA HOTELS
HOTEL
/ADDRESS
/PHONE/FAX
Courtyard by Marriott
/ 2777 Fairfield CommonsBeavercreek, OH45431 /
937-429-5203
937-429-2757Fairfield Inn
/ 2500 Paramount Pl.Beavercreek, OH45434 /
937- 427-0800
973-242-8480Hampton Inn
/ 2550 Paramount Pl.Fairborn, OH45324 / 937-429-5505
937-429-6828
Holiday Inn
/ 2800 Presidential Dr.Fairborn, OH45324 /
937-426-7800
937- 426-1284Homewood Suites
/ 2750 Presidential Dr.FairbornOH45324 /
937-429-0600
937-429-6311Marriott Residence
/ 2775 Fairfield CommonsBeavercreek, OH45431 /
937-427-3914
937-427-0275Red Roof Inn
/ 2580 Colonel Glenn Hwy.Beavercreek OH 45434 /
937-426-6116
937-426-7575SPECIALTY LEASING PROGRAM
The Mall at Fairfield Commons Specialty Leasing Program offers both local entrepreneurs and established companies the opportunity to create higher levels of success than ever thought possible.
By using one of the most dynamic and traveled parts of The Mall at Fairfield Commons, the common area, retailers can be right in the middle of the action, offering up-to-the-minute new products and services. Our state of the art custom Retail Merchandising Units (RMUs) in effect create your own miniature store, that, when merchandised properly and staffed professionally, can revolutionize the way you do business.
In addition, The Mall at Fairfield Commons offers the opportunity to lease select stores throughout the center on limited-time availabilities, to showcase new products, or offer more inventory, at peak seasons.
Contact Connie Nichols, Specialty Leasing Manager, or Jennifer Green, Specialty Leasing Coordinator in the Management Office for more information.
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OPERATIONS & MAINTENANCE
EMERGENCY CONTACT INFORMATION
Please complete this form and return it to the Management Office. Please be sure this form is updated as necessary.
Store Name: ______
Space #: Store #:______Store Phone #: ______
Manager’s Name: ______
Manager’s Phone #: (Home)______(Cell/Pager)______
Assistant Manger’s Name: ______
Assistant Manger’s Phone #: (Home)______(Cell/Pager)______
Emergency Contact for Store: (IN SEQUENCE TO CALL)
- Name:______Phone #: ______
- Name: ______Phone #: ______
- Name: ______Phone #: ______
Home office or Parent Company (If Applicable):
Name of company: ______
Operations Contact Name/Title: ______
Address: ______City: ______
State/Zip: ______Phone #: ______
Fax:______E-mail:______
District/Area Manager (If Applicable):
Name:______
Business Address:______City: ______
State/Zip:______Phone #:______
Fax: ______E-mail______
Marketing/Advertising Contact (If Applicable):
Name: ______
Address:______City:______
State/Zip: ______Phone#:______