Dealer Application

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Dealer Application

* Required Entry

Primary Applicant Name	*
Social Security #	*
Secondary Application Name
Social Security #
Home Phone
Office Phone
Address	*
City	*
State	*
Zip Code	*
E-Mail Address	*
Date of Birth
Marital Status	Married Single Other
Residence	Own Rent
Give a brief description of building or sales background (if any).
If you have been, or are currently self employed, please describe.
Would you or an appointed individual, if awarded a dealership, be able to visit our facilities for training?	Yes No
List two personal or business references
First Reference Name
Address
City
State
Zip Code
Telephone

Second Reference Name
Address
City
State
Zip Code
Telephone

List the sales territory in which you want to represent American Log Homes.
If you were awarded an American Log Homes dealership, what category would be of interest to you?	Model to live in or sell from Model to sell from only Sell model to first customer
Describe your present employment responsibilities.
Describe what opportunity you see in the log home business in your awarded territory.
Describe why you believe you would be successful as an American Log Home dealer.

704.602.3035 Phone

704.319.2250 Fax