Therm Tec, Inc.
P.O. Box 1105 Tualatin, Oregon 97062
Phone (503) 625-7575 Fax (503) 625-6161 E-Mail thermtec@earthlink.net
Web Page http://www.thermtec.com
Rep-Ques L-125
PROSPECTIVE REPRESENTATIVE INFORMATION REQUEST

Company: ______________________________________________________________
Contact Person: _________________________________________________________
Street address: __________________________________________________________
City: ____________________State: _______________Zip Code __________________
Country: _____________________
Phone: ______________________ Fax: _________________________
E-mail: ___________________________ Web page: ____________________________
Territory of Distribution interest: __________________________________________

We thank you for your interest in the Therm Tec Incineration and Air Pollution Control Systems that we Design, Engineer and Manufacture here at our Oregon facility.

We are interested in having your organization represent and supply the Therm Tec Equipment in your area.

In order to service your request properly, we would like to have some information about your company that we can review and then be entered into our computers for future reference.

NOTE: ANY AND ALL INFORMATION PROVIDED SHALL BE HELD IN THE STRICTEST OF CONFIDENCE.

We would appreciate your taking a moment to provide the following information:
1.    Total number of employees in your organization: _____________
       Engineers: ______
       Service Technicians: ______
       (Technicians for BURNER EQUIPMENT) ________
       (Technicians for Computer, Electrical and PLC Systems)______
2.    Approximate Gross Volume of Sales (USD) for the last two years ______
3.    Other Products or Equipment that your company represents __________
       (Please Fax a short list of companies that you are currently doing business with)
4.    Physical size of your facility - in Sq. Ft. :______________
5.    Will your computers accept E-mail, or 3.5" disks from Auto Cad 14______
         (Used for sending drawings and other information to you for projects)
6.    Years in business: ______

We thank you for your courtesies and look forward to a good relationship.
Please fax this information to us at your earliest convenience.

Respectfully, Therm Tec, Inc.