Kooler Ice - Distributor Inquiry Form

Name *	required
Business Name
Address 1
Address 2
City		Zip
State:
County:
Phone number *	required
Fax number
Email address*	required
Current job title
Employer
How many years have you worked this job?
Describe your duties
Prior work experience
Why are you interested in becoming a Kooler Ice distributor?
What skills do you have that would make you a successful Kooler Ice distributor?
What counties are you interested in having the exclusive rights to sell, support and service the Kooler Ice machines: (list counties)
Do you have an interest in owning some of the Kooler Ice machines in the above counties? Or is your interest to primarily sell and support the machines in the above sales territory? (Please explain)
How much capital do you have to available to invest?
What is your net worth?
Which best describes your interest in being a Kooler Ice distributor:
What is your timeframe in purchasing a Kooler Ice Machine:

The information contained in this form is for informational purposes only and is not intended for the solicitation of a Kooler Ice distributorship or for the sale of a Kooler Ice distributorship. Filling out this form does not constitute an offer to be a Kooler Ice distributorship.