Home / Prospective Distributor Questionnaire 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.