Contact First and Last Name:*

Email Address:*

Phone:*

Company Name:*

Company Address:*

Federal Employer Identification Number (FEIN):*

Dun & Bradstreet Number (D&B):

Number of Years in Business:*

Target Industry:* Target Industry:*Commercial/ProfessionalEducationMaker/Consumer

Number of Locations:*

Please List All Locations:*

Total Number of Employees:* Total Number of Employees:*1-2021-5051-200201-500501-2,000More than 2,000

Number of Sales Employees:*

Number of Technical Support Employees:*

Annual Revenue:*

Please Describe Your Company (VAR, Brick&Mortar Retailer, E-Retailer, etc.):*

Regional Territory Served:* Regional Territory Served:*North East USACentral USASouth/South East USAWest USA

Where are you going to sell (Cities, States, Districts)? Please be accurate in your description as this is how we will determine non-compete/exclusivity.*

What market segments (Secondary Schools, Post Secondary Schools, Maker/Hacker Spaces, etc.) and customer types do you currently serve? Please be specific, as this will be used to determine the area of non-compete/exclusivity.*

Do you sell any products/services similar to those of Leading Edge Industrial?* Do you sell any products/services similar to those of Leading Edge Industrial?* Yes No

What products/services do you currently sell?*

Why do you feel that you would be a good distributor of Leading Edge Industrial products?*

What motivates your customers to buy through you? How do you distinguish yourself as a distributor?*

If approved, please state how you plan to market and promote Leading Edge Industrial products. Please detail marketing action plans for 30, 60, and 90 days.*

Does your company exhibit at trade shows/conferences? * Does your company exhibit at trade shows/conferences? * No Yes

Please list the trade shows, conferences, etc. that your company attends each year:

If approved, how many LEI CNC machines do you plan to sell in the next 12 months?*

How did you hear about the Leading Edge Industrial? [Select all that apply]* How did you hear about the Leading Edge Industrial? [Select all that apply]* Leading Edge Industrial Website Distributor Referral Customer Marketing - Magazine Marketing - Email YouTube Other