PrimeTime Interest Form
Name
*
First Name
Last Name
Email
*
example@example.com
Company Name
*
Company Website
*
Does your company currently offer a product or service to Nationwide Marketing Group Members:
*
Please Select
Yes
No
Unsure
Please list the product/service.
Please describe the product or service that you offer and how it would be beneficial to independent retailers.
Please select the area of business your product or service supports:
*
Please Select
Merchandising: Appliances
Merchandising: Furniture & Bedding
Merchandising: Consumer Electronics
Merchandising: Other
Marketing: Digital
Marketing: Other
Business Services
Financial Services
Other:
Please list the other area of business your product or service supports.
How did you hear about NMG?
*
Please provide referral contact name if applicable.
Submit
Should be Empty: