Please register by completing the following form. You will be contacted by our consignment specialist who will discuss in detail our consignment program and answer any questions you may have.

First Name

MI

Last Name

Company Name

Company Address

Suite

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Tel #	Fax #

Type of Company

Contract Manufacturer Sub-Assembly Contractor Military Contractor Aerospace Microwafe/RF Government Agencies Telecommunications Distribution Medical Equipment Computer Equipment Consumer Electronics Other

Your Job Function/Title

Purchasing Agent Purchasing Manager Materials Manager Surplus Sales Coordinator Director of Purchasing Inventory Control Other

175 Central Ave. Farmingdale, NY 11735 | toll free 800-762-4536, 631-227-3000