Pre-Sales Application and Questionnaire
Welcome to our household purchasing cooperative! We look forward to a long and prosperous relationship with your company.
Please note that the application must be filled out in its entirety, or else your application will be discarded. Incomplete or missing fields will cause delays in processing.
Once your completed application is received, please allow 4-18 weeks for processing. You will be notified in writing if your application has been approved. The household purchasing cooperative meets on the 5th Wednesday of every month, and reviews all applicants in a fair and timely manner.
Company Name __________________________________________________________ Company Address __________________________________________________________ Company Phone __________________________________________________________ Your Name __________________________________________________________ Your Address __________________________________________________________ Your Phone __________________________________________________________ Your Driver’s License # __________________________________________________________ Your Social Security # __________________________________________________________ Mother’s Maiden Name __________________________________________________________ Best time to call __________________________________________________________
Questionnaire
Section 1 – Company Information
1) What product or service are you offering for sale?
____________________________________________________________________________________ 2) What benefits does your product or service offer?
____________________________________________________________________________________ 3) Why didn’t your company purchase Segways for you to ride on? That would be cool.
____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
4) Is your company certified as a Green Business? Just recycling your Hot Pockets box and Red Bull cans from lunch doesn’t count, so let’s hear what you’re doing:
____________________________________________________________________________________ ____________________________________________________________________________________
5) Does your company regularly contribute to charitable causes that I agree with? If so, please detail which ones, along with the amounts. Please also detail what percentage of the sale is donated to these charitable causes, both as a percentage of the sales price and as a percentage of the gross sales of the company. Be sure to include the percentage devoted to administrative costs and advertising.
____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
6) Does your company regularly contribute to political causes that I agree with? If so, please detail which issues, organizations, candidates, or ballot measures this company has contributed to since 2004 (attach additional documents as needed).
____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
7) Do you personally regularly contribute to political causes that I agree with? If so, please detail which issues, organizations, candidates, or ballot measures you have contributed to since 2004 (attach
additional documents as needed). If you contributed to the income tax initiative, or didn’t sign the petition for privatizing liquor sales, set the clipboard down and walk away. Really.
____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
Section 2 – Personal Preferences
Please circle Like or Dislike for the following questions, to indicate your personal preferences:
Politics Animals
8) Seattle transit tunnel Like Dislike 39) Kittens Like Dislike 9) Marijuana legalization Like Dislike 40) Polar Bears Like Dislike
10) Income tax Like Dislike 41) Pigeons Like Dislike
11) Inheritance tax Like Dislike 42) Ferrets Like Dislike 12) Sales taxes on soda Like Dislike 43) Manatees Like Dislike 13) Pledge of Allegiance Like Dislike 44) Spiders Like Dislike
14) Barack Obama Like Dislike 45) Aibos Like Dislike
15) Sarah Palin Like Dislike 46) Barn Owls Like Dislike 16) Lyndon LaRouche Like Dislike 47) Snipes Like Dislike 17) Leonard Peltier Like Dislike 48) Pygmy Goats Like Dislike
18) Liberals Like Dislike 49) Octopi Like Dislike
19) Conservatives Like Dislike 50) Werewolves Like Dislike 20) Libertarians Like Dislike 51) Narwhals Like Dislike 21) Anarchists Like Dislike 52) Baby Seals Like Dislike
22) Tea Party Like Dislike 53) Furbys Like Dislike
23) Christan Coalition Like Dislike 54) Gnats Like Dislike 24) World Worker’s Party Like Dislike 55) Cougars (not milfs) Like Dislike
Celebrities Colors
25) Mario Lopez Like Dislike 56) Red Like Dislike
26) Mario Andretti Like Dislike 57) Moss green Like Dislike
27) Super Mario Like Dislike 58) Magenta Like Dislike
28) Corey Haim Like Dislike 59) Yellow-Orange Like Dislike
29) Corey Feldman Like Dislike 60) Blue Like Dislike
30) Corey Allen Like Dislike 61) Sparkles Like Dislike
31) Tim Allen Like Dislike 62) Stripes Like Dislike
32) Lily Allen Like Dislike 63) Dots Like Dislike
33) Milli Vanilli Like Dislike 64) Stars Like Dislike 34) Vanilla Ice Like Dislike 65) Stars and Stripes Like Dislike
35) Ice T Like Dislike 66) Orange Like Dislike
36) Rupert Murdoch Like Dislike 67) Pink Like Dislike
37) Rupert Boneham Like Dislike 68) Off white Like Dislike 38) Rupert Gee Like Dislike 69) Spelling it “colours” Like Dislike
70) What is your favorite Constitutional Amendment and why?
____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
71) Will Simon Cowell’s X Factor bring in higher ratings than American Idol in 2011? Why or why not? ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
72) Will Tea Party activists elect more Republican candidates in 2010, or will they split the conservative vote, thereby electing more Democrats? Please explain your answer in detail.
____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
73) Team Jacob or Team Edward? Explain your answer in detail.
____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
74) Which incarnation of Doctor Who was the best in your opinion, and why?
____________________________________________________________________________________ ____________________________________________________________________________________ * If you are offering a product for sale, please proceed to Section 3.
Section 3 – Product for Sale
75) Please describe the product in detail, and include information relevant only to its physical characteristics, such as size, measurements, general dimensions, color choices, materials used in construction, material gauges (if applicable), country of origin, factory location(s), results of any durability or fading tests, stress tolerance levels, ISO certification, etc. Attach documentation as needed.
____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
Indicate if your product can perform any of the following tasks by circling Yes or No: 76) Bounce higher than 6 feet when dropped from a level of 12 feet: Yes No
77) Make my fish perform tricks, such as jumping through hoops on command: Yes No 78) Make me smarter than you (remember, I’m grading this): Yes No
79) Cook a whole turkey in under 7 minutes: Yes No 80) Watch my children while I go out drinking: Yes No 81) Put my pants on both legs at a time: Yes No
82) Keep my house bug-free for the next 100 years, guaranteed: Yes No
83) Allow me to simply flip the roof tiles over to use the other side, rather than replacing them: Yes No 84) Provide a summary of the day’s news with an extremely liberal or conservative bias: Yes No 85) Includes a “Get out of jail free” card: Yes No
86) Has the ability to make both snow cones and Krusty Pups: Yes No
87) Will drive my idiot neighbor crazy, and eventually into a sanitarium: Yes No
88) Would still work or be edible after a nuclear holocaust, assuming I could get it into my underground bunker in time: Yes No
89) OK, I didn’t make it to the bunker. Would it still work or be edible?: Yes No 90) Makes a really cool sound when smashed: Yes No
91) Will finally make me feel loved. Oh God, I’m so lonely: Yes No
92) Please indicate if any of my neighbors purchased this product, how much of it, and how much I would need to purchase to out-do them.
____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
Section 4 – Services Offered
Please provide the following information about the person actually providing the service:
Name ________________________________________________
Address ________________________________________________
Phone ________________________________________________
Driver’s License # ________________________________________________ Social Security # ________________________________________________
Reported income for 2003 ________________________________________________ Mother’s Maiden Name ________________________________________________
Vehicle Type ________________________________________________
Year, Make, Model ________________________________________________ License Plate # ________________________________________________
Does it have a cool radio? ________________________________________________
Does it have a tow hitch? ________________________________________________
Can it tow a 20-foot boat? ________________________________________________ Can we borrow it? ________________________________________________
Please indicate if the service provider is willing or able to perform these additional tasks: 93) Wash my car as needed: Yes No
94) Wash my back as needed: Yes No
95) Watch my children while I go out drinking: Yes No
96) Seriously, though, what about the back washing? Just think about it; no pressure: Yes No 97) Pick up after the dog when it barfs on the carpet: Yes No
98) Pick up after me when I barf on the carpet: Yes No 99) Help set the table for dinner: Yes No
100) Drive to Tacoma to pick up a package from a guy; no questions asked: Yes No
