Prospective Dealer Questionnaire

Mailing Address

City State Zip                                                                      

Work Phone# (      ) -                                     

Home Phone # (       ) -                                  

Fax # (      ) -                                      

E-Mail Address                                                                                    

Marital status M / S                                                    

Last year of school completed                                                                  

Company Name                                                                                                                                              

dba (if any)                                                                                                                                                      

Years in Business                                    

# of employees                                        

Breakdown of Business:                                                                            

% Commercial % Residential                                                                    

Proposed Area of Trade                                                                                                        

Population of Trade Area                                                                                                        

Would you be interested in financial assistance?    (circle one)             YES           NO

Please give a brief description of your current business experience.                                                                

Please mail or fax this completed questionnaire to:

Kevin Lipscomb, President

Outdoor Decor, Inc.

P.O. Box 700906

San Antonio, TX 78270-0906

voice: 800-317-4777

fax: 210-545-1230

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