Distributor Information Request Form Name: Address: City: State: Zip: Daytime Phone: Email Address: How many sales persons in your operation? Who is your primary market? List the corresponding percentage range for all that apply. Automotive Dealers/Repair Shops: Less than 10% 10%-50% More than 50% Choose Percentage Fleet Sales: Less than 10% 10%-50% More than 50% Choose Percentage Detail Shops: Less than 10% 10%-50% More than 50% Choose Percentage Industrial: Less than 10% 10%-50% More than 50% Choose Percentage Janitorial: Less than 10% 10%-50% More than 50% Choose Percentage Institutional: Less than 10% 10%-50% More than 50% Choose Percentage Recreational Vehicle: Less than 10% 10%-50% More than 50% Choose Percentage Other: Less than 10% 10%-50% More than 50% Choose Percentage Do you currently carry other product lines? Yes No If so, which one(s)?