Sales Agency Engagement Online Form Sales Agency Engagement Online Form Primary Contact InformationName* First Last PhoneEmail* Agency InformationLegal Entity NameAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Office PhoneTax IDWebsiteOrganization TypeCorpLLCPartnershipSole PropietorDoes your company currently hold a valid commercial liability insurance policy?*YesNo# 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 InformationWhat 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*NotePhoneThis field is for validation purposes and should be left unchanged. Δ
