Independent Representative - Questionnaire Form

Independent Representative Questionnaire

Company Name

Physical Locations with Addresses

Mobile Phone Number

Email Address

Do you have a physical location in the country you are applying to represent ASI?(Required)

Website Address

Years in Business(Required)

Total Number of Employees(Required)

Do you have any current applications for our analyzers / products?(Required)

Industries Covered Regularly

List Customers Covered Regularly

How many full time outside sales?

How often cover sales area?

List geographical areas you wish to cover

Number of salesmen will be assigned to ASI(Required)

Identify analyzer of prime interest to sell(Required)

Identify analyzers secondary interest to sell(Required)

How many of each model analyzer can you sell in the next year? The liquid analyzers are the highest priority due to higher value and limited competition.(Required)

Do you require ASI visits in your territory? Provided details.(Required)

Number of service techs working full time ?(Required)

Do you provide analyzer installations and field service?(Required)

Number of analyzers installed in past?(Required)

Will you obtain the certifications required to sell in your country if necessary?(Required)

Time & cost for registration (if applicable)(Required)

Time & cost required for vendor approval (if required)(Required)

Offer help for registration and vendor approval if required? Advise details.

Is it likely to sell analyzers before any lengthy registration and or vendor approval if required ?(Required)

Provide complete tender documents. Samples if required.

Accepted file types: jpg, png, pdf, doc, xls, csv, Max. file size: 50 MB.

List show exhibit participation if any

List current analyzer manufacturers you represent(Required)

Do you represent any competitive analyzers? If so, how can we resolve this conflict ?(Required)

Will your company agree that it will not sell/represent or service competitive analyzers?(Required)

Will your company agree to list our analyzers on your website and have at least one link to LiquidGasAnalyzers.com?(Required)

When will you complete our analyzer listing on your website?(Required)

Advise primary contact information with email and phone of 3 instrument manufacturers you represent as references.

List analyzer manufacturers you represent with contact information including email of mfg. person responsible

Additional comments/concerns

Become a Representative

Independent Representative Questionnaire

Independent Representative Questionnaire