TriaTek Control Solutions - Page 19

TRIATEK Account Application

Please complete all questions and fax to (770) 242-1944 or mail to TRIATEK Sales Department, 2976 Pacific Drive, Norcross GA 30071

Company Name:_________________ Phone:___________________

Shipping Address:_______________   City/State/Zip:______________

Billing Address: _________________ City/State/Zip:______________

Phone Number: (___)_______ Fax:__________ email:_____________

Number of Employees:________ Years Established:________

Authorized Purchasing Agents:________________________________

Fed. Tax ID Number:

Please print names of all sales and engineering personnel for our mailing list:

Approx. Monthly Revenues:_________Is your business: Incorporated, Partnership,  Sole Proprietorship

What State?________ If subsidiary, name of parent company:________

If Sole Proprietorship, please provide us with principal owner's home address:________________________________________________

________________________Home Phone: (_____)______________

Type of Company: HVAC Contractor,  Mechanical Contractor,

Electrical Contractor, BAS/Control Contractor, System Integrator,

Hospital Contractor, Other - please specify__________________

For which Building Automation System Supplier are you currently authorized to be a Dealer/ Representative:

Alerton, American Automatrix, Andover VAutomated Logic ,
Carrier, CSI, Honeywell, Johnson Controls, Landis & Staefa, Siebe, Teletrol, Trane, Company, Other, please Specify_____

From which companies do you currently buy sensors, transducers, lighting controls or other interface equipment?