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Fax: 515-955-6636
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Please fill out the survey below to qualify for a free sample issue of Municipal Connection!

1. What is your primary business? Please select the category that best describes your business (required)

Heavy Construction

A.	Heavy Construction - General and special trade contractors primarily engaged in the construction of heavy projects, underground construction, excavating, marine construction and /or the construction of projects other than building erection
B.	General Construction - Contractors primarily engaged in construction of heavy buildings (not residential)
C.	Engaged in Both - Contractors substantially engaged in both categories described above
D.	Highway/Street or Road/Bridge Construction - Contractors primarily engaged in construction of highways, streets and roads, bridges/overpasses.
E.	Other Contractors - Electrical, demolition, mechanical and other contractors Please specify:

Building / Light Construction / Other

A.	General Contractor
B.	Producer (sand, gravel, stone, lime, cement, ready mix, asphalt)
C.	Dealer/Distributor of Parts, Attachments, Supplies, Accessories
D.	Consulting Engineering Firms
E.	Construction Management Firms
F.	Other Please specify:

Governmental Offices Please select one category that best describes your agency's function

A.	Federal (Department, Bureau, Agency, Authority, Province)
B.	State (DOT, Highway & Bridge Dept, Tollway, Turnpike, Airport)
C.	County (Highway & Bridge Department, Airport)
D.	City/Municipality (Streets & Bridges, Traffic Control, Airport, Rail)
E.	Township (Town Roads & Highways)
F.	Other Please specify:

2. What is your primary job title? (Required)

A.	Executive Level: CEO's, Chairmen of the Board, Owners, Partners, Presidents, Vice Presidents, CFO's, Treasurers
B.	Management Level: Administrators, Managers, Supervisors, Superintendents, Foreman, Engineers, Purchasing Agents, other executive officials
C.	Government Administration
D.	Public Works Operations
E.	Township (Town Roads & Highways)
F.	Other Please specify:

3. Do you have the authority to specify, select, rent and/or approve purchase of the following equipment, supplies and/or materials? (required)

A. Yes
B. No

4. If yes, check all that apply. (required)

	A.	Earthmoving, Excavating, Grading, Compaction Equipment
	B.	Trucks, Trailers and Truck Bodies
	C.	Paving Equipment
	D.	Road Maintenance Equipment (Pothole Patchers, Sealers, Sprayers, Spreaders)
	E.	Surveying Equipment
	F.	Recycling and Waste Disposal Equipment
	G.	Safety Equipment/Training
	H.	Traffic Control Equipment
	I.	Attachments (breakers, buckets, sweepers etc.)
	J.	Parts, Components (engines, drive trains)
	K.	Winter Maintenance Supplies & Equipment
	L.	Construction Materials
	M.	All The Above
	N.	None of the Above
	O.	Other Please specify:

5. Please send me the following publication(s) absolutely FREE!

Municipal Connection (based on survey qualifications)
Contractors Hot Line
Parts Connection (Based on survey qualifications)
Attachment Connection (Based on survey qualifications)

Please send my free sample issue to: (*Required)
Name:*
Email:*
Company:
Address:*
City:*
State:*
Zip:*
Phone:*
State of Birth:	(For verification purposes)

Municipal Connection is a division of Heartland Communications Group, Inc.
1003 Central Avenue, Fort Dodge, IA, 50501 | Ph: (515) 955-1600 | Toll Free: 800-247-2000