MARS® Representation Application Form
NOTE: the following information is held confidential

Corporate or
Company Name:

Street Address:

Post Office #:

City:

State / Province:

Zip / Postal Code:

Country:

Phone:

FAX:

Email:

Web Site URL:

Form of Organization:

:Sole Proprietorship / :Partnership / :Limited Company

Total Employees:

Total Outside Salesmen:

Total inside office staff:

Approximate company sales volume (yearly):

Describe your core business:

Describe your geographical territory:

Please list type of industries and customer base that you call on:

Please list product lines and names of other companies that you currently represent:

Product Line / Company Name / Territory / Annual Sales

Please list types of equipment (if any) you stock:

Would you be interested in Stocking MARS® Air Curtains: Yes / No

Please list the types of equipment (if any) you manufacture:

Trade/Business References, if any:

Name / Address / Phone / Fax

What specifically most interested you about MARS® ?:

Do you have an interest in:
Touring MARS®? Yes / No.
--- Touring a trade show where MARS® is exhibited? Yes / No
--- Other:

Comments: