Dealers Wanted

Basement Technologies offers the best possible foundation solution available anywhere, and is now seeking qualified installers who are interested in becoming Under-Pier System dealers.

If you are a professional in the construction or foundation industry, we would like to talk with you. Pleae fill out the form below.

Company Name:*	Contact Name:*

Position In Company:*	Phone with Area Code:*

Email Address:*	Street Address:*

City:*	State:* Zip:*

Desired Territory 1:	Fax:

Desired Territory 2:

Desired Territory 3:

Will you have partners besides you?
Yes No
If yes please explain who:

Type of Business:*	How did you learn about us?*
New Construction	Internet
Foundation Repair	Trade Show
Remodeling	Word Of Mouth
Engineering	Other
Do you have any structural repair experience?
Yes No
Do you currently offer structural repair services?
Yes No
If yes please explain:

Describe your professional background:

Have you ever owned a business?
Yes No
If yes please explain:

Have you ever owned a franchise, or been part of a dealer network?
Yes No

Are you currently employed?
Yes No

Have you declaired bankruptcy in the last 10 years?
Yes No
If yes please explain:

Your assets: Cash$:

Stocks, bones, mutual funds - non retirement accounts $:

Stocks, bonds, mutual funds - retirement accounts $:

Value of all real estate owned $:

Other assets $:

Total assets $:

Please explain assets listed as other:

How much of your own money are you looking to invest in this franchise? $:

Your liabilities total mortgages on all real estate $:

Other liabilities $:

Total liabilities $:

Please explain liabilities you listed as other:

Net worth assets minus liabilities $:


Please rate your overall Interest in owning a Basement Technologies Dealership:
I know about Basement Technologies, I meet your financial requirements and I want to open ASAP I see and hear your company name everywhere and Im interested in owning a Basement Technologies Dealership I am very interested in owning my own business, but have never heard of Basement Technologies I am currently just looking at several different business opportunities
You promise that you have supplied all information to the best of your ability and understand that we rely upon this information in assessing your qualifications. You understand that this prodile is not a contract and is in no way binding on you or us, and does not mean or imply that a franchise will be offered. Do you agree:?
Yes

All * fields are required