BECOME A DISTRIBUTOR WOULD YOUR COMPANY LIKE TO BECOME AN EVAC+CHAIR CANADA DISTRIBUTOR Fill out the following form to be considered for a distributorship. PROSPECTIVE DISTRIBUTOR QUESTIONNAIRE • • • • • • • • Please complete this questionnaire as thoroughly as possible so full consideration can be given to your suitability. Name Company Name Email Telephone Address Line 1 Address Line 2 City PROVINCE/TERRITORY CHOOSE PROVINCE/TERRITORY (IF APPLICABLE) Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Northwest Territories Nunavut Yukon ZIP CODE COUNTRY CANADA USA MEXICO ......................................... OTHER COMPANY URL # OF EMPLOYEES # OF SALES PEOPLE BRANCH OFFICES/WAREHOUSE LOCATION(S) WHAT REGION DO YOU CURRENTLY COVER? Would you be able to be a Stocking Distributor? YES NO Do you have Personnel to perform on-site Product Demonstrations? YES NO Would you be able to Conduct Training Sessions? YES NO Do you have the ability to Sell and Maintain Service Contracts? YES NO Would you appoint an Evac-Chair Specialist or Product Manager? YES NO SUBMIT DETAILS This document Does Not Constitute an Agreement with EVAC-CHAIR. MENU HOME EVACUATION CHAIRS EVACUATION SLEDS ACCESSORIES ABOUT US CONTACT US PRODUCTS EVAC+CHAIR 300H EVAC+CHAIR 500H EVAC+CHAIR 600H EVAC+CHAIR 700H EVAC+CHAIR POWER 800 CARRYLITE TRANSIT CHAIR EVACUATION CHAIR TRAINING EVACUATION CHAIR SERVICING EVACUATION CHAIR RENTAL ABOUT US WHY EVAC+CHAIR? OUR CUSTOMERS TESTIMONIALS NEWS E-BOOK DOWNLOADS FAQ's BECOME A DISTRIBUTOR ORDER FORM OTHER PRIVACY POLICY TERMS OF USE LEGISLATION FOLLOW US Facebook Twitter Linkedin