DEALER APPLICATION

Street Address

Type of business
Total number of personnel
Total sales per year (U.S.$) Less than 500,000 500,000 - 1 million 1 - 2 million 2 - 5 million 5 - 10 million 10 - 20 million Over 20 million

Products of interest
Moisture measurement Batching controllers
Silo weighing Custom weighing systems
Load cell transmitters/accessories
Concrete mixers   Mixer washout systems
Chi Mei products Load cells   Scales

Product lines presently sold or manufactured

Territory
Geographical area (state, country or boundaries of your coverage)
Industries to be covered (Example: ready-mix concrete plants, process control etc.)

Estimated total sales of our products per year (U.S.$) Less than 50,000 50 - 100,000 100 - 200,000 200 - 500,000 500,000 - 1 million Over 1 million

Do you sell products of our competitors? If so, what brands

Are you willing to do local advertising or split the cost with us Yes No Maybe later Not applicable (explain in text area)

Name of company, person and phone/fax numbers whose products you currently distribute, who we can contact for reference

What action would you like us to take? Catalog and prices Brochures (state type and quantity) Call to discuss We will contact you when ready No further action required

Other

Send following type and quantity of literature

If you are not the key person or decision maker, who is?