Hard Surface Installer Questionnaire

Name of Company*

Date*

Type of Business (Products/Services)*

Contact Person*

Title*

Address*

Street Address City State / Province / Region ZIP / Postal Code

# of Locations*

Is This Your Full Time Work?*

Phone*

Email*

Website

Years in Business*

Incorporated or Privately Held*

Number of Employees*

# of Workers that will Install Adsil*

Do you Have a Sales Force?*

# of Sales Reps*

Preparation for our coatings is a primary function of the job. What type of equipment do you have for cleaning/preparing surfaces?*

What is it that you see in Adsil and our product line that meets your future plans?*

Type of Account Base (Check All That Apply)*

Able to provide a Certificate of Insurance with a $1 million liability policy to Adsil? This is mandatory.*

How was it that you came to know about Adsil?*

CAPTCHA