Distributor/Representative Questionnaire
Company Name
Employer ID # or SSN
Your Name
Title
To help us determine how we can best work together, we ask that you answer the following:
Number of Machinery Sales People
Do you have Service Technicians	Yes No If so, how many?
Primary Territory
Primary Machine Brands Sold
Which of our products are you primarily interested in selling?	Conveyors Other Material Handling Processing Machines Ctrl click for multiple selections
Please specify the preferred method to use for sending quotes to salespeople with appropriate contact information: (If either method is acceptable, please give information for both.)
Name:	Fax : Phone:	Email
Name:	Fax : Phone:	Email
Name:	Fax : Phone:	Email
Do you currently sell any Return Conveyors Yes No If so, which brand(s)?