Report In Form

Business Name *

Contact Name *

Title:

Phone Number:

Dollar Amount Shifted:

Is this amount a one_time shift or will it be a recurring purchase?
One_TimeRecurring

If recurring, how often will you make this purchase?
WeeklyMonthlyQuarterlySemi_AnnualAnnual

Which category best describes your purchase?
Accounting (including auditing and bookkeeping)Advertising (print, radio, TV, etc)Architectural ServicesBuilding ServicesBankingConcreteComputer and Data ProcessingElectronics (including computers, printers, etc)Furniture and FixturesInsurance CarrierInsurance Agents and BrokersLegal ServicesManagement and Consulting ServicesMedical SuppliesMillworkMotor Freight Transportation and WarehousingOffice SuppliesPackaging (including paperboard containers and boxes)Personnel ServicesPrintingResearch and Development ServicesRetail SalesSecurity and Commodity BrokerageTransportation ServicesWholesale TradeOther (please specify)

Other:

Where did you purchase these products/services prior to your shift?
OnlineOut of StateAnother County in Iowa