| Date submitted |
*(mm/dd/yy) |
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| E-mail |
* |
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| First Name |
* |
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| Last Name |
* |
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| Title |
** |
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| Company |
** |
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| Address 1 |
* |
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| Address 2 |
** |
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| City |
* |
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| State |
* |
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| Zip |
* |
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| Country |
* |
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| Phone |
* |
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| Fax |
* |
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| How did you hear about us? |
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| How did you first find our website? |
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| What territory/states do you service? |
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| How many outside salesmen do you employ? |
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| What percent of your customer base can use the products that Yates manufactures? |
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| How long have you been in business? |
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| years |
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| How many product lines do you carry? |
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| Please attach line card |
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| Do you represent any competing lines to Yates? if so, which product and who are the manufacturers that you represent? |
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| Please list the value of annual purchases that you think your company will buy from Yates for this year and next year? |
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| If we need to request credit information about your company, who should we contact? |
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| What are the most important issues that we can control to assure our mutual growth and strong relationship? |
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