Avlis Midwest Company
837 Fairway Dr · Bensenville, IL 60106
Phone: (630)350-9500 · Fax: (630)350-0555
Email: sglatt@Avlis.com

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General Company Information
A. Company Name ______________________________________________________
  Address ______________________________________________________
  City & Country ______________________________________________________
  Phone # _______________________________
  Fax # _______________________________


B. Company Contacts

  Name Telephone Fax
Inside Sales _______________________ ___________________ __________________
Outside Sales _______________________ ___________________ __________________
Shipping _______________________ ___________________ __________________

Questionnaire


A. Is your company public or privately owned? ___________________________________

B. Do you define yourself as: Broker Yes   No
  Agent Yes   No
  Retailer Yes   No
  Manufacturer Yes   No
  Other (explain)    

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

C. If you are a retailer:

How many stores do you have? ________________________

D. If you are a distributor:

How many sales people work for you? ___________________________

Number of warehousing locations? ______________________________

E. If you are a manufacturer:

What kinds of products do you produce? __________________________________

____________________________________________________________________

____________________________________________________________________

F. What territory / country / region does your company cover? __________________

____________________________________________________________________

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