Note: To respond to requests for information we need your complete name, address and phone number. In addition, in order to better answer your request, fields marked with a must be filled out to submit. Thanks!

		E-mail address:
		Full Name:
		Company
		Phone number:
		Fax number:
		Street Address:
		City:
		State, Province or other:
		Zip or Country Code:
		Country:

How did you find out about Weather-Bos™?

(You must check at least one.)

Home Show/Trade Show
National Advertising
World Wide Web
Previous Usage
Referral
Other (if checked, you must describe)

Indicate your current type of business:

(You must check at least one.)

General Contractor
Subcontractor
Paint and/or Coatings Distributor
Paint and/or Coatings Manufacturer
Building Materials Dealer/Distributor
Developer
Wood or Building Products Manufacturer
Other (if checked, you must describe)

Which best describes your position?

(You may check more than one box.)

Owner, Partner or Principle
President, VP, Senior Executive
Independent Entreprenuer
Never Before Started Business
Other (if checked, you must describe)

What are your business sales goals for next year?

(Please check only one.)

Less than 2 Million
2 to 10 Million
10 to 25 Million
More than 25 Million

I would like to be a Weather-Bos™:

(You may check more than one box.)

Distributor/Manufacturer
Investor/Joint venture partner

In which state(s), country or countries
are you interested in being a dealer/ manufacturer?

(You must indicate at least one.)

State(s)
Country or countries

In what time frame do you see yourself
becoming one or both of the above?

(Please check only one.)

Less than sixty days.
Less than six months.
More than six months.

Which computer system do you use?

(So we can send you a CD-Rom.)

Macintosh
PC / Windows

Comments, questions, suggestions go here...

To help us better serve potential customers,
how did you find Weather-Bos™ on the Internet?