Please fill in the following information. For a printable version Click Here. Company Name City State Zip Phone Number Fax Number E-mail Address Contact Name Owners Name How long have you been in business? 1 to 5 years 5 to 10 years 10 or more years other What geography do you cover? What percent of your business is? 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Residential Replacement 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Residential New Construction 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Service How many employees do you have? 1 to 5 employees 5 to 10 employees 10 or more employees Service Techs 1 to 5 employees 5 to 10 employees 10 or more employees Installers 1 to 5 employees 5 to 10 employees 10 or more employees Sales 1 to 5 employees 5 to 10 employees 10 or more employees Office What type of advertising do you do? Yellow Pages Newspaper Television Billboards Direct Mail Radio What brands do you currently offer & why? How many years have you been handling your present brands? What are the top 3 things your current supplier does that keep you coming back? How would you rate your current distributor on the following? Poor Great Product Availability   1      2      3      4      5   Product Delivery     1      2      3      4      5   Tech Support   1      2      3      4      5   Technical Training   1      2      3      4      5   Business Training   1      2      3      4      5   Advertising   1      2      3      4      5   Add me to your email list

For more information about our fireplace please call 210-340-4623 or email us at fireplaces@incedist.com