Company Information:

Company name: 

Address: 

Address: 

Address: 

City:    State or Province:   

Postal code: 

Country:   

Company website address: 

Phone:  Fax: 

What is your company's gross annual sales?:

Number of employees:

Is your company:  Public    Private

Market and Selling Structure:

1. If you are located outside of the U.S.A., do you sell in the U.S.A. direct through
    your own U.S.-based sales force?


           Yes    No, and there are no plans to do so    No, but we would consider it

2. If you are located outside of the U.S.A., do you sell through a 3rd party company located
    in the U.S.A., which your company has ownership of either directly or indirectly?

           Yes    No, and there are no plans to do so    No, but we would consider it
 

3. Are you the manufacturer of the products you wish us to sell? Yes    No

If "YES", Please list the products you manufacture:

4. Do you offer U.S.-based Technical Support for these products?:   Yes    No

   - If "YES", what is the location of U.S.-based support: 


5. Please indicate the product(s) warranty: 


6. Would you want us to provide service and repair for the products?:  Yes    No

7. What is the estimated growth rate, for these products, for this year?: 

9. How does your pricing compare to your competition?:    

                                                   Higher    About the same    Lower

10. Does your company currently sell through distribution?: 

                                                   Yes    No, and there are no plans to do so    No, but we would consider it

11.  Have you allocated a pricing tier that would allow our participation as a distributor?:  

                                                   Yes    No, and there are no plans to do so   No, but we would consider it