Car Wash Equipment & Systems - PDQ Manufacturing, Inc

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PDQ Distributor Application

Due to the length of the application, it is recommended that you look over the application and make sure you have all required information present before beginning the online form. For your convenience, we have also included this application in Microsoft Word format (.doc) and Abode format (.pdf).

Download the application in Microsoft Word format (.doc)

Download the application in Adobe format (.pdf)

Company Contact
Name
Company
Title
Address

Street Address

Suite/PO/Secondary Address

City
State/Province
ZIP/Postal Code
Office Phone
Cell Phone
Fax
Email Address
   
Staffing
Type of Company
CORP
Partnership
Individual
Years in Business
Principal
 Title
Principal
 Title
Principal
 Title
Total # of Employees
Service Employees
Support Office Staff
Dedicated Equipment Sales Staff
 
Current Business
Current Car Wash Equipment Lines (please list all that apply):
Self-Serve
In-Bay Automatic
Tunnel
Entry Station
 
Territory(s) Currently Covered (states)
Projected Annual Volume for PDQ Equipment
# of Units
$
Parts
 
Lines Desired
PDQ Touch Free IBA
  PDQ Tunnel
  PDQ Tunnel and IBA
  PDQ Entry Stations
   
Reference
Vendor References: Name / Address / City / State / Zip / Phone
Reference #1
Reference #2
Reference #3
   
Customer References: Name / Address / City / State / Zip / Phone
Reference #1
Reference #2
Reference #3
   
Dun & Bradsheet Listed
Dun & Bradsheet Rated
   
 
   
     
   
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