Dear Prospective Dealer,

Welcome! We appreciate your interest in becoming an authorized dealer of our unique new Versa Lift & Versa Rail home improvement products. The Versa Lift & Versa Rail attic storage lift and attic stair railing are the perfect way to lift your profits! Please fill out all applicable areas of this Dealer Application Form.

Please help us understand your business and clientele so that we might offer better recommendations to fit your market area and business customer base.

Company Name *

DBA (Doing Business As)

Website Address *

Years in Business *

Business Structure *

Individual Owner

Partnership

Incorporated

How long has the company been under its present management? *

Primary Contact Name *

Phone Number *

Email Address *

Address

Business Address

City

State

Country

Enter your country

Postal Code

Address Type *

Business Address

Residence Address

Is your billing address the same as your shipping address? *

Yes

If No, please provide your billing address below.

Billing Address

City

State

ZIP Code

Name(s) of Owner/Officers: *

What cities and/or towns do you actively sell into? *

What forms of advertising do you use? *

Do you exhibit at local trade shows? *

Yes

Do you have outside salespeople? *

Yes

If yes, please list the trade shows you participate in.

If yes, how many?

How many home builders do you currently service as regular customers? *

How many home remodeling contractors do you currently sell to? *

How many homeowners do you sell directly to each month? *

How many homeowners do you sell directly to each year? *

To the best of your knowledge, what is the population of your market area(s)? *

What other home or garage-related products do you sell? *

Does your company install the products you sell? *

Yes

If no, who do you use for installations?

Outside independent contractors

Installation service firms

Builders self-install

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Which category would your annual sales fall into? *

Up to $250K

$250K to $500K

$500K to $1Million

$1Million to $3Million

$3Million to $5Million

$5Million to $10Million

Above $10Million

Where did you learn about us?

Tax Information Fulll Address *

State Resale Sales Tax Permit Number *

Federal EIN Number *