Rocket Man Mobile Beverage Systems

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PRODUCT INFORMATION COMPARISON ACCESSORIES FEATURES SIGN INSERTS ACTION PHOTOS WARRANTY PRICES STRAPS & BELTS

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Please complete ALL sections of the form. Required items are marked with an asterisk (*).

CONTACT INFORMATION:

COMPANY INFORMATION:

*Company Name:
*Mailing Address:
*Business Structure (corporation, partnership, etc.):
*Product/Service Description:
*Years Established:
*Number of Employees:
*Annual Sales (US Dollars) Year/Amount:
*Sales Territory Covered:
*Market Segment (beverage companies, bars/nightclubs, etc.):

CAPABILTIES:

*Number of Salespeople:			*Salary or Commission:
Size of Facilties (square footage):
*Office:		Warehouse:		Other:
Languages Spoken (check all that apply):
English	French	Spanish	German	Portugese
Other:

BANK INFORMATION:

COMPANIES REPRESENTED (list any U.S. companies first):
You must list at least ONE company.

*Company #1:
*Contact:
*Telephone:	Fax:
*Address:
*Annual sales volume with this company:
*Terms of sale (net 30, etc.):		*Credit Limit:
*Type of relationship (commission agent, exclusive stocking distributor, etc.):
*Product Description:

Company #2:
Contact:
Telephone:	Fax:
Address:
Annual sales volume with this company:
Terms of sale (net 30, etc.):		Credit Limit:
Type of relationship (commission agent, exclusive stocking distributor, etc.):
Product Description:

Company #3:
Contact:
Telephone:	Fax:
Address:
Annual sales volume with this company:
Terms of sale (net 30, etc.):		Credit Limit:
Type of relationship (commission agent, exclusive stocking distributor, etc.):
Product Description: