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Full Business Name
Address
City, State Zip
Telephone
FAX
E-mail
Company Website URL
Years In Business

            Contact Person(s)

            Name     Title    Email 

            Name     Title    Email 

            Products
            1)    What type of equipment do you sell?  
            2)    Is the equipment:      New    Refurbished Both
            3)    If Computers (estimate)    % of Software    Hardware    Softcosts    Installation, training, etc
            4)    Average Cost of Equipment
            5)    Approximate Annual Equipment Sales Volume
            6)    Do you currently have someone to finance your sales?  Yes  No
            7)    If Yes, please name the company.
            8)    Are you using monthly payments as a sales tool?  Yes  No
            9)    What items are most important to you?   Communications  Other
           10)   Are there any services or products that you would like to have from your current financing source that you are not getting now?
                   
           11)  Comments