Prospective Distributor Questionnaire - Dwyer Instruments | Dwyer Instruments

Prospective Distributor Questionnaire

Please complete this questionnaire as thoroughly as possible
so full consideration can be given to your suitability.
* indicates required field

COMPANY PROFILE
Country	*
Company Name	*
Address	*
Website Address:	*
Telephone Number	*
Contact Name	*
Title	*
Email Address	*
Branch Offices/Warehouses
Describe your business and provide details about your unique value proposition and differentiates your company to customers.
What is your present annual sales or sales turnover (U.S. Dollars)?	*
Number of Employees	*
Number of sales people	*	Outside Inside

TOP 5 COMPANY BRANDS AND PERCENTAGE OF TOTAL SALES
1st	*		*	% of Total Annual Sales
2nd	*		*	% of Total Annual Sales
3rd	*		*	% of Total Annual Sales
4th				% of Total Annual Sales
5th				% of Total Annual Sales

COMPANY FOCUS: Please specify your Top 3 target industries or markets
1st	*		*	% of Total Annual Sales
2nd	*		*	% of Total Annual Sales
3rd				% of Total Annual Sales

PRIMARY PRODUCTS OF INTEREST:		ANTICIPATED ANNUAL SALES OF PRODUCTS OF INTEREST:
*		*
*		*
*		*


ANTICIPATED SALES OF DWYER PRODUCTS:
*	after 1 year.
*	after 2 years.
*	after 3 years.

OTHER:
Do you have your own distribution transport?		Yes No
Would you appoint a DWYER specialist or product manager?		Yes No Name: Title:
Are you currently buying Dwyer products?		Yes No Distributor Name: How much Dwyer Products are you buying from them:
What Trade Shows do you currently participate in?	*
What would be your marketing plans to advertise, exhibit, and/or promote the complete DWYER product line?	*

*This document does not constitute an agreement between the applicant and Dwyer Instruments, Inc. as a representative of DWYER products.*