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Welcome to Neoteric – The Original Light Hovercraft Manufacturer

To complete Referring Agent, Dealer, or Distributor application on-line, use the form below. Items marked by an asterisk (*) are essential.

Note: While it is not essential to answer all questions, the more information available to Neoteric the better you can be judged suitable to undertake this program.
A. COMPANY INFORMATION
Business Name:  *
Address:  *
Address2:
City:  *
State:  *
ZIP Code:  *
-
Country  *
Telephone Number:  *
( )- -
Mobile Number:  *
( )- -
Fax Number:  *
( )- -
E-mail:  *
Web site:
Incorporation Date
Applicant Name
Position
Sales Tax Number
Federal Tax ID
Type of Business:
Corporation
Partnership
Proprietorship
Individual
Boat Dealer
Marina
 Sporting Goods
ATV Dealer
Auto
Motorcycle
Other
Building:
 Own
 Rent
Size:
 Office
 Show Room
 Service Area
Location:
 City
 Town
 Rural
  Main Highway
 Near Water
 On Water
B. Background
List trade names and addresses of parent or subsidiary companies:


List other Product Dealerships that you have:


C. INSURANCE DATA
Types of Insurance
Companies
Amount of Coverage

D. FINANCIAL DATA
Approximate Total Annual Sales for past three years for products listed under B:
Product 1.
Product 2.
Product 3.

E. REFERENCES: (list name, address and phone)
1.
2.
3.

F. PERSONNEL INFORMATION:
Officers/Owners
1.
2.
3.

Number of Employees:
Office Personnel
Sales Personnel
Certified Mechanics
Other, list

List clubs and organizations you belong to:


List community positions you hold or have held, e.g., President of Rotary:



Click Submit Button to Submit. You will be contacted to confirm or deny your application.

 
 

Neoteric Hovercraft, Inc.
1649 Tippecanoe Street Terre Haute, Indiana USA 47807-2394
Telephone: 812-234-1120 / 800-285-3761 Fax: 812-234-3217
Homepage: www.neoterichovercraft.com / www.rescuehovercraft.com
E-mail: hovermail@neoterichovercraft.com
© 2003 Neoteric Hovercraft, Inc, All Rights Reserved