Dealer Application

Company Information

Legal Company Name:

Contact Person(s):

Phone Number:

Email Address:

Company Website:

Company Address:

Do you have multiple Locations?: YesNo

If Yes, where are these offices Located?:

Marketing Procedures

Do you have a store front?: YesNo

How do you plan to market Concrete Floor Supply Products?:

Previous Purchasing History

Have you purchased concrete flooring products from other suppliers/manufacturers?: YesNo

If yes, who supplied/manufactured the products?:

On average, what percent of your business is "concrete flooring products"?: