Instructions and other important information:

You must complete this form in its entirety in order to be considered for Customer of the Month. Photos of yourself, your favorite trucks (if applicable) and other related images should be sent to Editor@AWDirect.com. Please send up to six photos and remember to include your company name when sending photos.

INCOMPLETE APPLICATIONS AND APPLICATIONS WITHOUT PHOTOS WILL BE DISCARDED

Name:
Company Name:
City & State:
Nature of your business:
Year Established:
How did you get into the business?
How large is your fleet?
How many employees do you have?
What is your favorite truck and why?
Please tell us your most interesting work-related story:
Have you ever won awards or commendations? If so, which ones:
Please list any and all community involvement:
Please list clubs and/or organizations you belong to:
Why do you feel you should be selected as Customer of the Month?
Email Address:
Please read below before checking this box:	I have read and agree to the terms and conditions as set forth below. Checking this box serves as my electronic signature of acceptance.

Don't forget to submit your photos! Send them to: Editor@AWDirect.com

TERMS AND CONDITIONS:
By submitting this form, you grant AW Direct, a Lab Safety Supply Company, all rights necessary to use the content contained herein, as well as your name and likeness, the name of your business and all photos you submit to AW Direct, on the AW Direct website and in any other AW Direct advertising, without limitation as to time or territory, and without your prior approval. Your name, likeness and any materials you submit may be published on the AWDirect.com website. Future use in the AW Direct print catalog and other promotions is also possible. All photos and other materials you submit become the property of AW Direct and Lab Safety Supply and will not be returned. AW Direct reserves the right to edit information and photos you submit prior to publication. One submission per company please. A coupon with a value of $100 will be sent via email to each month's winner at the time the winner is published on the AWDirect.com website. The coupon will be valid for website orders only and can not be combined with other offers. No purchase necessary to be considered for Customer of the Month Questions regarding this promotions should be directed to: Editor@AWDirect.com. Monthly winners shall be selected by the AW Direct staff. Winners will be notified via email. All decisions are final.