<*** Beginning of form ***> Companies Specializing In Products For The Blind. New Listing Form. Use this form to submit information about your company for possible inclusion in our list of Companies Specializing In Products For The Blind. Items marked with an (*) are required; your company will NOT be listed if any of the required information is not provided. The rest of the items are recommended but optional. Please provide your name and E-Mail address so we can contact you if needed. If you'd like you can choose a password which you will then be required to use any time you update your company's listing. The password is an extra precaution but is not a guarantee of security. * Do you work for this company? ___Yes - I work for this company. ___No - I don't work for this company. * Contact's Name: __________ * Contact's E-Mail: __________ Password: __________ Company Web Site URL: http://_________________________ * Company Name: __________ Suite #: * Company Street Address: P. O. Box: __________ * City: __________ * State: __________ * Zip Code: __________ * Country: __________ * Voice - Phone: (___)___-____ TDD - Phone: (___)___-____ TOLL FREE - Phone: (___)___-____ FAX - Phone: (___)___-____ E-Mail You can list up to 5 E-Mail addresses. You can also provide a description or person's name for each of the 5 E-Mail addresses. E-Mail: Name or description - name@company.com E-Mail 1: E-Mail 2: E-Mail 3: E-Mail 4: E-Mail 5: Company Description Your company description must meet the following requirements and may be edited for length and/or clarity. 1. Be no more than 75 words. 2. Should only describe the products available and avoid hyperbole. (Like the plague ... or was that cliches. :) ) Company Publications List the publication(s) produced by your company; catalogues, brochures, magazines, newspapers, etc. Include the name and how often each is published. Please put one publication per line or separate multiple items with a blank line. This list is not intended for listing articles published by individuals or companies in journals, magazines, newspapers or other periodicals. 1. 2. 3. 4. 5. Type of products sold Choose all that apply. ___ Books - Braille, large print, audio. ___ Braille - Braillers, slate, stylus, printers, Braille paper. ___ Electronics - Recorders, radios, TVs, telephones, VCRs, Stereos, DVD. ___ Games - cards, board games, computer games. ___ Home - Sewing, cleaning. ___ Kitchen - Measuring devices, guides, timers. ___ Magnifiers - Closed circuit TV, lenses, screen magnifying programs. ___ Medical - scales, thermometers, diabetes related, blood pressure. ___ OCR - systems, scanners, programs. ___ Screen readers - speech output, Braille output. ___ Time - watches, clocks. ___ White canes - canes, tips, other mobility items. ___ Other - please specify. _________________________ Comments: <*** End of form ***>