Your Name:

Address:

City:

State:

Select State Alabama Arkansas Alaska Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code:

Company Name:

Address:

City:

State:

Select State Alabama Arkansas Alaska Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code:

Telephone:

Fax Number:

E-mail:

Are you currently selling other agricultural related products?  If yes, what products?

Select Answer Yes No

How much territory would you travel to sell and service customers? (Mile Radius)

How much time do you have available to invest in selling and servicing BioZyme customers?

Select Answer 3 or more days a week 1-2 days a week Less than 1 day a week

What marketing support do you feel would be most effective in your sales area?

   Select Answer Open House Producer Meeting Local Advertising Direct Mail In Field Sales Ration Balancing and Nutrition Consultation

Other Suggestions or Comments:

In general, how would you describe your knowledge of livestock nutrition?

In general, how would you describe your knowledge of the BioZyme Nutrition System with the Amaferm Advantage?

How would you rate the factors below as they relate to a livestock producer's decision making process when selecting a nutrition program?  [Please place a 1 through 10 beside each where 10 is the highest rating]

     Convenience of Feeding

Local Availability

     Service

Research

     Price

Return on Investment

     Neighbor's Testimony

Product/Company Recognition

     Product Benefits/Performance

Promotions/Giveaways/Incentives

What motivated you to inquire about a BioZyme deaerlship?

Would you be willing to organize and host a producer meeting?  [BioZyme personnel would give presentation. Expenses for initial meeting would be paid by BioZyme.

Select Answer Yes No

Would you be willing to submit, to BioZyme, a list of prospective customers for direct mail and/or email correspondence?

Select Answer Yes No