Prospective Agent Questionnaire

 

Name
Telephone
Street Address
Fax
City
State
Country
Zip Code
E-Mail Address
How Long In Business
In This Territory
Territory Covered
Place Of Busniess
Home/Office
Number Of Salesmen
Is our Firm: Incorporates/
Partnership/ Solely Owned
Number Of Motor Line
Previously Sold
If Previously Selling Motors,
Why Change

 

Type Of Clients

Percent Motor Sales
Contractor
Industrial
Jobber
O.E.M
Total 100%

 

Mfg. Name Product Yrs. Sold Approx. Annual Sales
1.
2.
3.
4.
5.
6.
7.

 

Reference 1
Reference 2
Reference 3
Signed:
Date:

Peerless-Winsmith, Inc.
1401 W. Market St.
Warren, Ohio 44485
Attn: General Manager

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