CHAPARRAL MACHINERY
Sales Agent Registration Form

To register as a sales agent, print this page, fill in your information, sign the form, and fax.
To: Dave Stilley, Chaparral Machinery (972) 313-1984

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Sales Agent Page

An asterisk (*) indicates required information.

Information about you (Sales Agent):
*Your Name:
_____________________________________________________________
Your Company/Organization:
_____________________________________________________________
*Your Address:
_____________________________________________________________
*Your City, State, Zip:
_____________________________________________________________
Your Phone:
_____________________________________________________________
Your Fax and/or E-mail:
_____________________________________________________________
Information about the Prospect:
*Prospect's Name:
_____________________________________________________________
*Prospect's Company/Organization:
_____________________________________________________________
*Prospect's Address:
_____________________________________________________________
*Prospect's
City, State, Zip:
_____________________________________________________________
*Prospect's Phone:
_____________________________________________________________
Prospect's
Fax and/or E-mail:
_____________________________________________________________
*What type of product(s) is the prospect considering? Check all that apply:
Vertical Machining Center Horizonal Machining Center CNC Lathe
Questions? Comments? _____________________________________________________________
_____________________________________________________________

We MUST have your written acknowledgement of these conditions and terms, including your fee expectations,
prior to the date of the first price quotation and prior to any negotiations.

Please register me as a Chaparral Machinery sales agent for the above named prospect.

_________________________________________ Date: __________________________
 Signature