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.

  1. Describe the current ownership of your company

  2. What geographical territorial boundaries are desired for representation?
  3. Primary Markets Served

  4. Products currently represented and contacts

  5. Bank/credit card references

  6. Please submit the following about your company
  7. Price product lines wanted for representation
    Yes No
    Yes No