Option 1) Please complete the following application. After receiving it, we will provide you with a profit comparison using your sales figures and a link to our online merchant area which will give you complete program information and our Merchant Presentation Slideshow.

Option 2) If you do not wish (or have time) to complete the survey at all right now, but are interested in our program: Click Here to send an Email to our Sales Dept, include your name and phone number, and we will contact you.

How You Found Us:

Select One NARI Replacement Contractor Remodelers' Journal Referred by Someone Buzz Remde NERF Sales Rep. VPI Program Ad or Website Link Got an Email Received Mailer Google AltaVista MSN Yahoo AOL Other Search Site

Please Describe:

( Enter rep. name, referrer's name, promotional code, search words, etc.)

Company Name:

*

Your Name:

Your Position:

(Owner, manager, salesrep, etc.)

Decision Maker:

(If not you, who can sign a contract with us)

Work Phone:

Fax:

Cell Phone:

Best Time to Call:

(Time(s) of day / evening, best day(s)

Street:

City:

State:

Zip:

Your Website:

Email:

Annual Gross Sales:

Annual Number of Sales:

Starting / MSRP Price:

(Use an average / typical sale)

Average Discount:

(Off of same starting / MSRP price above)

Promos / Freebies Cost:

(Value of incentives, extras, and giveaways)

Cost of Goods:

(Hard cost not including discounts / promos)

Net Sales Price:

(Avg. walk out the door price)

Net Margin:

Best Season:

(Season or month(s) you do the most sales)

When to Start Program:

(When would you plan to kick-off rebating)

Number of Sales Staff:

(Not including owner)

Current Advertising:

(What media and marketing you use)

Annual Ad Budget:

Type of Business:

Select One Corporation LLC Franchise Partnership Sole Proprietor

Retail or Service:

Select One Retail Service Wholesale Internet Only

Years In Business:

Number of Stores:

Store Locations:

Products Sold:

(Or Services)

Marketing Promotions:

(What incentives, specials, freebies, etc)

Past Rebating:

(Have you rebated in the past? What type?)

Current Rebating:

(What rebates do you currently offer...instant?)

Rebate Cost:

(Amount of rebate)

Questions or Comments:

CONFIDENTIALITY AND NON-COMPETE AGREEMENT We are asking you to complete a survey that contains certain financial information that you probably do not want shared with your competition. This agreement will ensure we keep all of your information confidential. Additionally, we ask that you agree not to share some of our information or attempt the unlicensed use of this program. This agreement is for protection of both parties. Thank you for your understanding and discretion. 1.1. Each party shall keep strictly confidential all information of a confidential nature relating to the affairs and business of the other and/or to its holding and/or subsidiary companies and shall not disclose any of such information to a third party, other than its employees and/or officers as will of necessity acquire it as a consequence of the performance of that party's obligations under this Agreement (In which case the relevant party shall assume that each such employee and/or officer shall keep such information confidential and shall not use any of it for any purpose or disclose it to any person, firm or company other than those for which or to whom that party may lawfully use or disclose it under this Agreement). 1.2. Condition 1.1 shall not apply to any confidential information to the extent that it: 1.2.1. Comes within the public domain other than through breach of Condition 1 1.2.2. Is required to be divulged by any court, tribunal or governmental authority with competent jurisdiction; or 1.2.3. Is disclosed on a confidential basis for the purposes of obtaining professional advice. 1.3. As a material part of the consideration of this agreement, the undersigned agrees for a period of two (2) years from the date of this agreement not to directly or indirectly engage in any business which is in any way competitive with the business of National Rebate Fund (NRF, Inc. ), or its subsidiaries, whether as an employee, officer, share holder, partner or otherwise and Merchant agrees not to consult with or advise any such business which is in any way competitive with the business of NRF, Inc. 1.4. In the event that the undersigned party and NRF, Inc. do not enter into further agreement within three (3) months from the date of this agreement, the other party agrees to return to NRF, Inc. all written information, documents, materials and copies thereof in their possession relating to the NRF, Inc. business and promotions. 1.5. The Confidentiality Condition 1.1 shall remain in effect for five (5) years from the date of this Agreement. 1.6. The parties recognize that the damages that will be suffered by NRF, Inc. as a result of Merchant's breach of this Agreement will be substantial but will also be difficult to determine. They also recognize the delays, expense and difficulties involved in proving in a legal proceeding the actual loss suffered by NRF, Inc. in the event of breach. Accordingly, instead of requiring any such proof, NRF, Inc. and Merchant agree that as liquidated damages (but not as a penalty) for each violation of this Agreement, Merchant shall pay NRF, Inc. the sum of $10,000 for each such breach. The parties acknowledge that these damages are a fair and reasonable estimate of the damages being suffered. 1.7. This Confidentiality and Non-Compete Agreement shall be governed by and construed in accordance with the laws of the State of Colorado. By submitting this email form, this Confidentiality Agreement is hereby agreed to and accepted according to the conditions above and the undersigned duly authorized representatives have caused its execution