Dwyer Instruments - Prospective Distributor Questionnaire

Dwyer Instruments, Inc.
P.O. Box 373 - 102 Highway 212
Michigan City, Indiana 46361-0373
Sales Only: (219) 879-8000 General Office: (219) 879-8868
Fax: (219) 872-9057

Prospective Distributor Questionnaire

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

COMPANY PROFILE:
Contact Name:
Company Name:
Address:
Telephone Number:
Fax Number:
Email Address:
Website Address:
Number of Employees:
Branch Offices/Warehouses:
Senior Executives: (Name, positions, and qualifications)
What is your present annual sales (U.S. Dollars)?:
Number of sales people:	Outside Inside
What region/countries do you presently cover?

TOP 5 PRODUCT LINES AND PERCENTAGE OF TOTAL SALES:

1st % of Total Annual Sales Growing Declining Flat

2nd % of Total Annual Sales Growing Declining Flat

3rd % of Total Annual Sales Growing Declining Flat

4th % of Total Annual Sales Growing Declining Flat

5th % of Total Annual Sales Growing Declining Flat

COMPANY FOCUS: Please specify your Top 3 target industries or markets Key Applications in that market:

1st % of Total Annual Sales

2nd % of Total Annual Sales

3rd % of Total Annual Sales

PRIMARY PRODUCTS OF INTEREST:
Check all that apply ANTICIPATED SALES OF DWYER PRODUCTS:

Pressure Switches/Transmitters after 1 year.

Flow Switches/Transmitters after 2 years.

Level Switches/Transmitters after 3 years.

Temperature Controls/Transmitters

Humidity Transmitters

Valve Indicating Switches

Valves

OTHER:

What technical qualifications do your sales people have?

List of existing companies and products represented:

Do you have your own distribution transport? Yes No

Would you appoint a DWYER specialist or product manager? Yes No

Why should DWYER select you as a distributor, and future business partner?

What Trade Shows do you currently participate in?

What would be your plans to advertise, exhibit, and/or promote the complete DWYER product line?

Please list your bankers names and addresses and two other principle names from whom commercial references could be obtained.

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

TOP 5 PRODUCT LINES AND PERCENTAGE OF TOTAL SALES:
1st	% of Total Annual Sales	Growing Declining Flat
2nd	% of Total Annual Sales	Growing Declining Flat
3rd	% of Total Annual Sales	Growing Declining Flat
4th	% of Total Annual Sales	Growing Declining Flat
5th	% of Total Annual Sales	Growing Declining Flat

COMPANY FOCUS: Please specify your Top 3 target industries or markets		Key Applications in that market:
1st	% of Total Annual Sales
2nd	% of Total Annual Sales
3rd	% of Total Annual Sales

PRIMARY PRODUCTS OF INTEREST: Check all that apply	ANTICIPATED SALES OF DWYER PRODUCTS:
Pressure Switches/Transmitters	after 1 year.
Flow Switches/Transmitters	after 2 years.
Level Switches/Transmitters	after 3 years.
Temperature Controls/Transmitters
Humidity Transmitters
Valve Indicating Switches
Valves

OTHER:
What technical qualifications do your sales people have?
List of existing companies and products represented:
Do you have your own distribution transport?	Yes No
Would you appoint a DWYER specialist or product manager?	Yes No
Why should DWYER select you as a distributor, and future business partner?
What Trade Shows do you currently participate in?
What would be your plans to advertise, exhibit, and/or promote the complete DWYER product line?
Please list your bankers names and addresses and two other principle names from whom commercial references could be obtained.

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