DISTRIBUTOR/DEALER
QUESTIONNAIRE AND APPLICATION

The following information must be provided in order to be candidate as a distributor of EDS products. Please provide as much information as possible.

Thank you very much for your willingness to become a dealer & distributor of EDS USA Inc, manufacturer of the Liberty Solar Box - worldwide patented revolutionary Residential PV Solar Water Heating Solution.

Please read carefully the following questionnaire and respond as much as you can please in order for EDS USA, Inc. to better understand your business and your marketing target.

PLEASE NOTE: THIS QUESTIONNAIRE DOES NOT CONSTITUTE A CONTRACT OR ANY OFFER FOR DISTRIBUTORSHIP. EDS RESERVES THE RIGHT TO ACCEPT OR REJECT THIS QUESTIONNAIRE AT ITS DISCRETION.

*  All fields marked in red are mandatory fields.


  1. COMPANY INFORMATION
  2. Company Name:
    Street Address:
    P.O. Box:
    City/State/Province:
    Postal Code: Country:
    Telephone Number: - /
    Country Code Main Number Extention, if any
    Fax Number: -
    Country Code Main Number
    Person To Contact: Title:
    E-mail Address:
    Mobile Number:
    Company Website:
    Please indicate your type of business: Other:
  3. ORGANIZATION
  4. What year was your business established?
    Indicate number of years in solar energy-related business
    Is your company a division or subsidiary of another company?
    How many people does your company employ?
    How many sales representatives are in your company?
    Please provide us with your company's sales (in USD) for the following years: 2009   More:
      2010   More:
      2011   More:
      2012   More:
  5. SALES & MARKETING
  6. What solar energy manufacturers and products do you currently represent?
    How do you promotionally support your product lines in general?Advertising: Promotions:
    (Must select at least one) Consumer Magazines
    Newspapers
    Trade Magazines
    Local Radio
    Television
    Other:
      In-store events
    Special pricing
    Direct-mailings
    Sample support
    Other:
    What markets do you focus on?    Government       Contractors       Re-Sellers       Consumer      Other:
    (Must select at least one)
    Please select the states or cities or countries where you are requesting distribution rights:

    You can select more than one state by holding the Ctrl key (or command key for mac)


    Other country:
    Do you have experience in solar equipment sales?
    Are you subject to specific Tariff rates/Import duties on certain solar energy products?   
    Are you subject to international sales tax or VAT tax rates?   
  7. PRODUCT INFORMATION
  8. Do you want to purchase one or more units now for testing prior to our final decision on your distributor application?   
  9. REGISTRATION & LICENSING
  10. Are separate licenses or registrations required for you to distribute/sell our products?   
  11. SALES PROJECTIONS
  12. For sales projections of Liberty Box please choose one of the options below.
    If you wish to go beyond your local market, contact us for additional information.
    1st Year of Sales
    2nd Year of Sales
    3rd Year of Sales
  13. REFERENCES - Click to open
  14. CONFIDENTIALITY/NON-DISCLOSURE/NON-COMPETE
  15. You have requested approval as a distributor for EDS products. Any agreement between you and EDS will contain promises from you to protect all confidential information and trade secrets of EDS, and to refrain from competing with EDS and its other distributors.

    THE FOLLOWING INFORMATION MUST ACCOMPANY THIS QUESTIONNAIRE:
    • Business License or Authorization to Import
    • A corporate brochure from your company, if available

 EDS USA Inc- www.usa-eds.com © All Rights Reserved
EDS USA Inc Address: 113 South Monroe Street Alliance Center, First Floor Tallahassee FL 32301
Tel: (850) 2017303 Fax: (850) 2017101
Israel Center: Atidim Technological Park, Bldg.1 P.O.B. 58092 Tel-Aviv, 61580 Israel
Tel: +972-3-6485294 / +972-774080162 / +972-774080163 Fax: +972-3-6485295