2016 Mobile Distributor of the Year Page1 / 9 11% of survey complete. Questions marked with a * are required Your Information (We may contact you to follow up with additional questions on your nomination.) Question Title * Name: Question Title * Title: Question Title * Company: Question Title * Location (city, state): Question Title * Phone: Question Title * Email: Question Title * How do you know this distributor? (Select one) I am a customer I am a district manager I am a competitor I am a fellow flag distributor with a different route Other (please specify) Nominee's Information (The distributor you are nominating): Question Title * Name: Question Title * Company: Question Title * Location (city, state): Question Title * Phone: Question Title * Email: Question Title * Years in the Business: Question Title * Annual Revenue: Under $50,000 $50,001-$100,000 $100,001-$250,000 $250,001-$500,000 $500,001- $1 million $1 million or more Unsure Question Title * Primary Territory Description: Rural City/Urban Town/Suburban Question Title * Customer Base (check all that apply): Automotive Service Stations Heavy Duty or Fleet Repair Facilities Aircraft Maintenance Facilities Industrial / Manufacturing Facilities Body Shops / Collision Repair Marine Repair ATV / Off-Road Service Centers New / Used Automotive Dealerships Farm / Agriculture Educational Facilities / Tech Schools Other (please specify) Next