Your Name:

Company Name:

Address:

City: Select State Alaska Alabama Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Missouri Mississippi Minnesota Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip:

Phone: Fax:

E-mail:

Website:

Number of booths: 1 2 3 4 5 6 7 8+

A contract will be mailed to you for the next show after this questionnaire
and product information checklist has been returned.

1. Are you the only or sole distributor in the U.S. of this product?.

Yes No

2. Do you use an independent sales force?

Yes No

If yes, please give firms name(s):

3. Can this product be imported and sold in the U.S. by any other companies?.

Yes No

4. Is there a factory sales rep already in the show with the same product?

Yes No

If yes, please list names of each:

5. Which of the following categories applies to your company?

Importer Exclusive Distributor

Manufacturer Independent Rep Firm

Other:

Please print this page and fax to: 951-277-1599