All information submitted will be kept confidential. Company Name * Submitted by * Email * Section 1: Company Basics Contact Details Address 1 Address 2 City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Phone (Office) Phone (Mobile) Preferred Contact Number Ownership Information Name(s)% Owned Name(s) % Owned Name(s) % Owned Add more Other Details Corp Structure: C, S or LLC Fiscal Year End Annual Sales Company History Website Employees/Staff Sales Warehouse/Drivers Customer service Office Other Other Ops Data Union Yes No Ave Order Size Facility ownership/lease info Computer Software Number of Delivery Trucks Other Vehicles Shop Yes No If yes how many techs and what equipment authorized to repair Section 2: Product Offerings Top Ten Vendors VendorEstimated % of VolumeRelationship since (what year?) Vendor Estimated % of Volume Relationship since (what year?) Vendor Estimated % of Volume Relationship since (what year?) Vendor Estimated % of Volume Relationship since (what year?) Vendor Estimated % of Volume Relationship since (what year?) Vendor Estimated % of Volume Relationship since (what year?) Vendor Estimated % of Volume Relationship since (what year?) Vendor Estimated % of Volume Relationship since (what year?) Vendor Estimated % of Volume Relationship since (what year?) Vendor Estimated % of Volume Relationship since (what year?) Vendor Estimated % of Volume Relationship since (what year?) Participation in Buying Groups Buying GroupEstimated % of VolumeRelationship since (what year?) Buying Group Estimated % of Volume Relationship since (what year?) Buying Group Estimated % of Volume Relationship since (what year?) Add more Section 3: Customers and Markets Trading Area MarketEstimated % of Volume Market Estimated % of Volume Market Estimated % of Volume Add more Market Sectors Served SectorsEstimated % of VolumeOutlook for Sector Growth Sectors Estimated % of Volume Outlook for Sector Growth Sectors Estimated % of Volume Outlook for Sector Growth Add more Key Customers (over 5% of total sales) CustomersEstimated % of VolumeCurrent?Outlook for Account Growth Customers Estimated % of Volume Current? Outlook for Account Growth Customers Estimated % of Volume Current? Outlook for Account Growth Add more Key Competitors CompetitorsMarkets Served Competitors Markets Served Competitors Markets Served Add more Other Details Typical payment terms Credit Cards Select all Appropriate Special payment programs Bad debt issues Recent sales performance (growth in 2013 & 2014) Outlook for market growth in 2016 & 2017 2015 YTD Section 4: Sales Team Including executive management involved in sales/customer development Team NameResponsibilityYears Industry ExperiencePotential Hire? Name Responsibility Years Industry Experience Potential Hire? Name Responsibility Years Industry Experience Potential Hire? Add more Customer interface CustomersEstimated % of VolumeOutlook Customers 1. Telemarketing Estimated % of Volume Outlook Customers 1. Telemarketing Estimated % of Volume Outlook Customers 1. Telemarketing Estimated % of Volume Outlook Customers 1. Telemarketing Estimated % of Volume Outlook Other Information Other Information Notes Submit
