Kan-Go-Roo Playgrounds: Distributor and Playground Installer Registration Form

• Become a Distributor

Enterprise Name:

Contact Person:

Address:

City:

Province:

Country:

Postal Code:

Phone:

Fax:

E-mail:

Website:

# Year of operations:

0 - 5 5 - 10 10 +

# of employees:

Category of your company:

Annual sales turnovers:

Work Territory:

Field of Expertise:

Heavy equipment available:

Auger	Backhoe
Pea Gravel Truck	Safety Gate

Normal Business:

Desired relationship with Kan-Go-Roo:

How would you promote Kan-Go-Roo products? (Ex.: Trade Show, Website, etc.)

How many sales personnel would promote Kan-Go-Roo products?

How would you organize equipment installations?

Additional relevant information:

Fax proof of commercial general liability and any certifications related in playground or equipment installation at 1-888-789-0987.

Please provide 3 contact names for reference purpose:

Name Business Phone

1)

2)

3)