Sales Agency Engagement Online Form

Primary Contact Information

Name*

First Last

Phone

Email*

Agency Information

Legal Entity Name

Address

Street Address Address Line 2 City State ZIP Code

Office Phone

Tax ID

Website

Organization Type

Does your company currently hold a valid commercial liability insurance policy?*

Yes
No

# of Years in Business*

Please enter a number from 0 to 100.

# of Employees*

Please enter a number from 0 to 100.

# of Sales Reps*

Please enter a number from 0 to 100.

Agency Marketing Channel*

Door to Door (Residential)
Door to Door (Commercial)
Telemarketing
Commercial

Background Information

What markets have you sold in?*

What markets are you currenty licensed in? (Please list all Broker/Agent licenses by market)*

What market do you currently sell in?*

What markets are you interested in selling in?*

What ESCO's have you worked for?*

Describe the Organization's energy-related experience and industry knowledge.*

Please identify the market segment in usage thresholds that the Organization targets*

Please describe the Organization's core business function*

What is the primary focus of your business? (i.e. residential, schools, real estate, etc.)*

What are the anticipated sales results on an annual basis in terms of number of customers and MWh volume?*

Please provide details on your sales market strategy for customer acquisition (i.e. door-to-door, cold calling, referrals, etc).*

Has the Organization ever had a broker agreement terminated by a supplier? If yes, please explain.*

Is the Organization or any employee of the Organization subject to any enforcement or disciplinary action by a regulatory body of the subject to any pending or threatened lawsuit, action, or any legal proceeding related to its/their business conduct? Has the Organization or any employees of the Organization been the subject of any such actions in the past three (3) years? If yes, please explain.*

is the Organization subject to any non-compete and/or non-disclosure agreements that would affect the services that you would provide for Broadway Energy? If yes, Please explain.*

Have you ever been convicted of, or plead guilty or no contest to or have been the subject of a finding of guilt by a judge or jury to a criminal offense other than a minor traffic violation? If yes, please provide details of all offenses including nature, circumstances, and dates.*

Please provide a list of all Officers and Directors for your company and any other information pertinent to this application*

Note

Phone

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