Form Sa-42 - Annual Wholesale Trade Report Wholesale Distributors

Form Sa-42 - Annual Wholesale Trade Report Wholesale Distributors - 2010 Page 6

Form SA-42

Page 6

(09-24-2010)

REMARKS - Please use this space to explain any significant year-to-year changes, to clarify your responses, etc.

CONTACT PERSON - Certifies data are accurate and can assist with any questions

Name of person to contact regarding this report - (Please print)

Title

Telephone

Area Code

Number

Extension

Fax

Area Code

Number

THANK YOU

for completing your ANNUAL WHOLESALE TRADE REPORT

We suggest you keep a copy for your records

Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the

time for assembling data from existing records and completing this form. Send comments regarding this burden estimate

or any other aspect of this collection of information, including suggestions for reducing this burden to: Paperwork Project

0607-0195, U.S. Census Bureau, 4600 Silver Hill Road, AMSD-3K138, Washington, DC 20233. You may e-mail comments to

Paperwork@census.gov; use "Paperwork Project 0607-0195" as the subject. Respondents are not required to respond to any

information collection unless it displays a valid approval number from the Office of Management and Budget (OMB). The

OMB eight-digit number appears in the upper right corner of this form.

Form Sa-42 - Annual Wholesale Trade Report Wholesale Distributors - 2010 Page 6