Independent Representative Information Request

If you are interested in becoming an Independent Representative please take a moment to complete the following questions. Information submitted will be used by Timberpeg^® only, it will not be given to anyone else. Someone will contact you shortly upon completion. Items marked with an asterisk are required fields.

Contact Information

First Name: *

Last Name: *

Street Address: *

Street Address 2:

City: *

State: *

Zip: *

Country: *

When is the best time to call you?:

Phone Number: *

Company name:

If you currently operate as or own a company please tell us the legal name. I.E. "Smith Construction LLC".

Email Address:

Company website:

Please contact me via:

Email

Phone

How did you hear about us?

Magazine Ad (Choose from the list): - None -Custom HomeFine HomebuildingN.H. MagazineTFBC-Timber Frame Business CouncilTimber Home LivingWood Design & BuildingOther (Please note below)

And/Or:

Friend/Referral

Timberpeg Open House

Home/Trade Show

TFBC-Timber Frame Business Council

Saw Timberpeg in a Book

Internet Search Engine (Please note which used below-Google, Yahoo, etc.)

Another Website Referral (Please note website below)

Other (Please note below)

If you would like to give us any additional information regarding how you found out about Timberpeg, please do so here:

Independent Representative Info

What is your current line of business?:

Builder

Architect

Engineer

Sub-contractor

Realtor

Residential Designer

Lender

Other

If other, please describe:

In what geographic area(s) would you like to be an Independent Representative?:

Please describe any related experience you have which you feel would make you a good Independent Representative:

How did you become interested in Timberpeg®?:

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