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AGENT SIGnup Application

Please be thorough in your answers. We intend for you to earn a great deal of money with us and, in the process, we need as much information as you can provide. Again, we appreciate your interest.

 Agent Application
1. Are you currently providing products and services to automobiles as an agent? Yes     No 
If no, then what type of business are you presently in?
2. What companies do you represent as an agent and which of the products are you providing to your automobile dealer clients and your sales volume?
    Company Monthly Volume # Of Dealers
Vehicle Service Contracts
  Credit Life and A&H Contracts
Security Systems
Chemical Supplies
Physical Damage Ins.
3. What is your current mix of dealer clients?
new car dealers
used car dealers
4. What areas of the country/province/region do you currently market?
5. How long have you been in your current business or position? years months
6.If we are to replace a provider you currently represent, why are you changing?
If not, what is your interest in INDS Canada?
7.How many people are in your organization?
Sales Staff Sub-Agents Support Staff
8. What type of training, if any, do you provide for your sales representatives?
9. Other than the factory sponsored programs, which companies have the largest market share and are your strongest competition in this area, and in your opinion, why?
10. Which agent in your area controls the largest market share and who does he/she represent?
11. How often do you visit with each of your dealer clients?
12. We have found that, in our business, one of the keys to success is making calls. About how many new prospects do you see each week?
13. What type of support would you like to see from your product suppliers or home office?
14. The delivery of high quality service is a key element in any business. Please list the names and telephone numbers of those people who know you and would tell us more about you.


Telephone Number

15.Tell us a little about your personal interests and hobbies
16. Any other comments
Name: Company Name
SIN# Corp. ID #
City/Province/Postal Code
Telephone: Fax: Email:

Thank you for providing this information. It will be helpful to us as we move forward with our selection of representatives and national product information. We will be in touch shortly and look forward to further discussions concerning this new and important opportunity.