Please Fill out this form to become an ETI Licensee.

We will respond to your inquiry as soon as possible.

 

Company Name
Company E-mail
Company Phone#
Company Address
Company Fax#


Form of Business(Sole proprietary, corporation)?
When was your company formed?
Who owns the company(respective percentage of ownership)?

Characterize your customers(%industrial,%Commercial,%Residential,%Others)


Briefly describe your company's operation.


Briefly describe the background and experience of the owners of your company

Describe the insurance coverage your company currently maintains
Who is responsible for the financial management of your company?
Number of people employed by your company: Administrative, Sales, and Technical
Does your company have any contingent liabilities?(Guarantees, Lawsuits, ect.)

List your company's primary suppliers/vendors:
include the Name of the Firm, Contact Name, Phone#, and Fax#.
#1
#2
#3

List your company's most Recent Clients
include the Name of the Firm, Contact Name, Phone#, and Fax#.
#1
#2
#3

List your company's banks and financial institutions
include the Name of the Firm, Contact Name, Phone#, and Fax#.
#1
#2
#3

Your desired Marketing/Sales Territory for ElectroFlow?

Thank you.