Opportunity Inquiry Form

ParkerStore HOSE DOCTOR^®

First Name*

Last Name*

Company

Address 2

City*

State*

Zip or Postal Code*

Country

Phone #

Email*

How did you hear about this opportunity? If referred by a distributor, which one?

Do you have a valid drivers' license in the state and/or country in which you plan to operate?

Are you legally able to work in the state/country in which you would like to operate?

What is your highest level of education?

Have you ever been convicted of a criminal offense?*

Are you willing/capable of providing 24/7/365 service?

Will you be operating in or near your current location? If no, where will your business be located?

Are you looking to add a PartkerStore HOSE DOCTOR to your existing service offering?

If yes, please provide the business name, description and years in operation

Do you currently have a vehicle you would like to use for your ParkerStore HOSE DOCTOR business?

If yes, please list the type of vehicle and its year, make, model and color

How many years of Business Management experience do you have?*

How many years of Sales experience do you have?*

How many years of Marketing experience do you have?*

How many years of Accounting experience do you have?*

How many years of Finance experience do you have?*

How many years of Business Software experience do you have?*

How many years of Hydraulics experience do you have?*

How many years of Gas/Diesel Engine experience do you have?*

How many years of Pneumatics experience do you have?*

How many years of Heavy Construction Equipment experience do you have?*

How many years of Material Handling Equipment experience do you have?*

How many years of Plant Maintenance experience do you have?*

How many years of Plumbing experience do you have?

How many years of Electrical experience do you have?

How many years of Carpentry experience do you have?

Typical startup costs can range anywhere from $50,000 - $150,000. Will you require financing?*