Energy Outfitters - Dealer Application Form

Dealer Application

Dear Potential Dealer:
Thank you for enquiring about Energy Outfitter's dealer program. Please fill out the following Dealer Application form for our evaluation.

You can also print the application and send it to us.
When we have reviewed your application, we will contact you.

Date
Company Name
Street Address
City
State
Zip
Mailing Address
City
State
Zip
Telephone Number	Toll Free:
Fax Number	Cell:
e-mail	Website:
Type of Business:	Sole Proprietorship Partnership Corporation Other

Names, Addresses & Phone of Owners, Partners or Principle Corporate Officers

Name:

Title:

Home Address:

City

State

Zip

Name:

Title:

Home Address:

City

State

Zip

Resale License

State

Contractor License

Type of License

Reseller

Yes No Not Applicable

Installer

Yes No Not Applicable

Years in Present Business

List Three Companies with Whom You
Have Open and Active Accounts

Company Name, Address, Phone, Fax, Contact

How do you intend to use our products?

Type of Market: (please check all applicable types)

Appliance Sales	Marine Systems & Sales
Remote Home Systems	RV Systems & Supplies
Water Pumping Systems	Bus Converter
Industrial Power	OEM
Communications Power	Mail Order

List all other types applicable:

Physical Plant Description:

Office Office at Home Warehouse
If other, please describe:

Do you wholesale products? Yes No

Do you retail products? Yes No

Check any of the following products you sell, or intend to sell.
Photovoltaic Panels	Wind Generators
Meters	Towers
Mounts	Microhydroelectric Generators
Trackers	Propane Refrigerators
Controls	Propane Ranges
Safety Disconnects	Instantaneous Water Heaters
Power Center	Water Pumps
Batteries	Energy Efficient Electric Appliances
Cables	AC Lighting
Inverters	DC Lighting
Battery Chargers	DC Ventilation
Generators
Add items not listed:

Please Describe Marketing Plan and/or Idea:

Do you presently, or have you ever installed equipment for others? Yes No
Number of years installing:
Number of installations:
Are you a licensed contractor? Yes No Type:
License Number:

Do you anticipate doing any future installations? Yes No
If yes, what type of system or equipment?

Describe any background or experience you have that will apply to the types of installations you may do or are doing:

Describe any training or education that you have in this area:

What licenses does your geographic area require for installers?

Do you plan to obtain the required licenses? Yes No If yes, when:

Do you presently, or have you previously designed systems? Yes No

Types of systems:
Number of years designing:
Number of systems designed:

Do you anticipate doing any system designing in the future? yes No
If yes, what types of system design will you be doing?

Describe any background or experience you have that can help you with the types of designing you may do:

Describe any training or education that you have in this area:

Describe any training or education you plan to acquire in this area:

When: Where:

Please include any additional information, comments or suggestions!