Pennsylvania Institute for Food Marketing, Education and Research

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Company Information Principal's First Name:

Principal's Last Name:

Title:

Company:

Address:

City:

State:

Zip Code:

Telephone:

Fax:

Web site:

Email Address:

Contact Information (If different from Principal Information) Contact's First Name:

Contact's Last Name:

Contact's Email Address:

Company Information For how many years has your company been established as a broker?

How many employees does your company have?

Products What types of products do you represent? Please select all that apply.

Services What services do you offer your accounts? Please select all that apply.

Businesses To which of the following types of businesses do you currently sell?

To what areas/regions do you currently sell? Please list

Are you interested in developing sales for you clients in international markets for example, Canada or Mexico?

Yes No

Do you participate with your clients at trade shows?

Yes No

If yes, to what extent?

How do you charge for your services?

Commission

Retainers

$/Hourly Fee

Other Special Fees:

Can a Pennsylvania food company looking for a food broker contact you directly to discuss possible interest in representing them?

Yes No

Would you like for someone from the Bureau of Market Development, Pennsylvania Department of Agriculture, to contact you to discuss their domestic and international marketing services?

Yes No

Other

Select all of the Mythical beings in the following list Tiger
Europe
Dragon
Zero
Nine