Dealer Application

Thank you for taking your time to complete this form.
We will credit US$100 on your first purchase.

General Information

Legal Company Name:
Business Name:
Address:
City:			Province:
Postal Code:			Country:
Tel:			Fax:
Email:
Website Address:
IEC (Import/ Export Code) (if applicable)
Affliated Companies: (Name and Location)
Number of Locations:
Total number of sales staff: (from all locations)	-- SELECT ONE -- 1-5 6-10 11-20 21-50 51-100 101-200 200+
Total number of technical staff: (from all locations)	-- SELECT ONE -- 1-5 6-10 11-20 21-50 50+

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Officers

President/Owner:		Social Security # (Optional):
Home Address:		Home Phone #:
VP Finance / Controller:		Purchaser:

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Company Type

Sole Proprietor Partnership Corporation		Business Type Retailer (storefront) Independent Manufacturer Repair Shop Distributor National Chain
Years in Business:
Annual Sales Volume:
Business Registration Number:
Province:
Provincial Sales Tax Number:
(Please attach copy of sales tax exemption certificate, if applicable)

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TRADE REFERENCES

(Do not include office supply companies, couriers, customs brokers)
Business Name:			Customer/ Account Number
Address:
City:			Province:
Postal Code:			Country:
Tel:			Fax:
Contact Person:

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Other Information

Petrol Engine Repair Experience of your Technical Staff:	-- SELECT ONE -- No Experience Minimal Moderate Expert
Do you or your staff request additional training in conventional power generator?	Yes     No
Does your company offer periodical training to upgrade your sales and technical staff? If yes, how often?
Do you rent or own the business premises?	Owned     Rent
Do you rent or own the business equipment?	Owned     Rent
Total square foot of your main location	-- SELECT ONE -- 1000-1999 2000-3999 4000-6999 7000-10000 10000+
Geographical business area	-- SELECT ONE -- My own State 2 – 5 States and Territories 6 - 10 States and Territories 11 States and Territories +
Are you selling or representing any power generator products?	Yes     No
(If you are, please state the brand and power range and since when)
Are you an exclusive agent for any power generator product?
If yes, please state the brand and since when and territory.
List your current portable generator suppliers and their phone numbers. (Optional)
How will you market our product? Please check appropriate boxes.	Through dealers Storefront Online Telemarketing Door-to-door Network marketing Home business Other
Does your company have a dealer network? If it does, how many dealers, and what are products?
Who are your major competitors in portable gas generator market? Please state their applicable fuel type (LPG only, or LPG+Natural Gas, or Petrol+LPG+Natural Gas), output wattage and current market price.
Are you carrying any propane gas generators?	Yes     No
If Yes, what are the sizes?	2-8 Kva    9Kva
Do you plan to stock our products?	Yes     No
Estimated Initial Purchase: (USD)
What are your estimated sales for the next 12 months?
If we have 2Kva Dual Fuel (LPG+Natural Gas) power generator in early 2009, what are your estimated sales for the next 12 months?
Do you import directly from China?	Yes     No
Do you attend private and/or government tenders? If you do, what products?
Do you have an affiliated company in Hong Kong or China? If you do, please write details in the box.
What else would you like us to know about you?