Business Legal Name

Address

City/State/Zip

Phone

Contact Name

Email Address

Website Address

# of Sales Offices

# of Sales Reps

Type of Equipment / Services Sold

Authorized Distributor For

Distribution Channels

Direct Sales

Independent Distributor

Wholesale

Re-Seller

Internet

Equipment Price Range $

to$

Average Transaction Size $

Annual Sales Volume

Current Annual Finance Volume

Average # of Finance Transactions Per Month

Which Finance Companies Do You Currently Use

What Would You Like to Improve About Your Current Finance Program

Notes