Dealer Application

Please complete this application form to get started as an Eagle Shield dealer. An asterisk (*) indicates a required field.

Personal
First Name:*
Last Name:*
Address:*
City:*
State:*
Postal Code:*
Country
Home Phone:*
Office Phone:
Mobile Phone:
Email
Dealer Plans
Will the dealership be owned and operated by you individually or a group?*
Amount of capital available for investment in this business:
Territory for which application made:
Would you consider any other territories?
Which ones?
How did you learn about Eagle Shield?
Why would you like to be part of an Eagle Shield Dealership?
What is your time frame for starting your dealership?
Business Experience:
Have you ever been in business for yourself?
What type of business? For how long?
Please describe your business experience including the kind of work you do now and have done in the past, the positions you have held, and the industries in which you have worked.
Education:
University attended:
Dates of attendance:
Degree earned:
University attended:
Dates of attendance:
Degree earned:
Additional Comments / Questions
- Keep me informed about more ways to stay comfortable and save energy

Personal