Prospective Distributor Questionnaire

Thank you for your interest in Price Pump products. In order to help us better understand how you would benefit our global distribution network, we request you take a few moments to answer the following questions and either email or fax the reply to our president or sales manager.

ALL FIELDS ARE REQUIRED

  1.
Describe the current ownership of your company
a. Public Company: 
b. Owner(s) Name(s): 
c. Name & Title of person completing this form: 
  2.
What geographical territorial boundaries are desired for representation?
a.    b. 
  3.
Primary Markets Served
a. d. g.
b. e. h.
c. f. i.
  4.
Products currently represented and contacts
Company Contact Name Phone/Email
a.    
b.    
c.    
d.    
  5.
Bank/credit card references
Bank/Company Contact Name Phone/Email
a.    
b.    
c.    
  6.
Please submit the following about your company
a. Organizational chart: (please use one of the following formats: .txt., .doc, .rtl or .pdf)
(Click Here to Upload Chart From your Local Hard Drive)
b. Shipping and mailing address for main office and other offices
c. Phone and email address 
d. Web site URL: 
e. Brief history of your company
  7.
Price product lines wanted for representation
AOD
Centrifugal

    


Price Pump ® 21775 Eighth Street East, Sonoma, CA 95476
Phone: 707-938-8441   |   Fax: 707-938-0764
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