Rewards Enrolment Form

Enrollment Form

To participate in the Brooks Rewards Program, please complete the below enrollment form.
An account overview must also be completed with your Account Manager, after enrollment,
to maintain enrollment benefits.

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* 1. Please provide the following information (Each of these 5 fields requires an answer).

*Brooks Acct #:

*Brooks Account Name:

*Name:

*Position Title:

*Email:

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* 2. Please provide the following additional information.

Phone #:

Cell #:

Type of Phone (iPhone, Android, etc.):

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* 3. Website:

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* 4. Please check the quality of service Brooks currently provides.
(1 being extremely poor; 5 being excellent)

	1 (Extremely Poor)	2 (Poor)	3 (Average)	4 (Good)	5 (Excellent)
a. Product Quality	a. Product Quality 1 (Extremely Poor)	a. Product Quality 2 (Poor)	a. Product Quality 3 (Average)	a. Product Quality 4 (Good)	a. Product Quality 5 (Excellent)
b. Packaging of Items	b. Packaging of Items 1 (Extremely Poor)	b. Packaging of Items 2 (Poor)	b. Packaging of Items 3 (Average)	b. Packaging of Items 4 (Good)	b. Packaging of Items 5 (Excellent)
c. Delivery Time	c. Delivery Time 1 (Extremely Poor)	c. Delivery Time 2 (Poor)	c. Delivery Time 3 (Average)	c. Delivery Time 4 (Good)	c. Delivery Time 5 (Excellent)
d. Friendliness	d. Friendliness 1 (Extremely Poor)	d. Friendliness 2 (Poor)	d. Friendliness 3 (Average)	d. Friendliness 4 (Good)	d. Friendliness 5 (Excellent)
e. Product Knowledge	e. Product Knowledge 1 (Extremely Poor)	e. Product Knowledge 2 (Poor)	e. Product Knowledge 3 (Average)	e. Product Knowledge 4 (Good)	e. Product Knowledge 5 (Excellent)
f. Customer Service Assistance	f. Customer Service Assistance 1 (Extremely Poor)	f. Customer Service Assistance 2 (Poor)	f. Customer Service Assistance 3 (Average)	f. Customer Service Assistance 4 (Good)	f. Customer Service Assistance 5 (Excellent)
g. Total Overall Experience	g. Total Overall Experience 1 (Extremely Poor)	g. Total Overall Experience 2 (Poor)	g. Total Overall Experience 3 (Average)	g. Total Overall Experience 4 (Good)	g. Total Overall Experience 5 (Excellent)

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* 5. Do you “will-call” (pick up) orders from your other suppliers?

a. If yes, how far do you drive to pick up?

b. If no, why not?

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* 6. What new products would you like to see Brooks supply?

a. Part, model#, and brief description?

b. Where do you buy these items now?

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* 7. What services could Brooks offer to help your business run smoother?

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* 8. Would you be interested in attending or sending your technicians to one of Brooks Emergency Light and Exit Sign Classes?

Yes

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* 9. How do you prefer to buy product? Please check all that apply.

a. Online–Computer

b. Online–Smart Phone

c. Email

d. Via Fax

e. Over the Phone

f. At the Will-Call Counter

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* 10. What other wholesalers do you buy from?

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* 11. What distributorships do you have?

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* 12. Do you service FIRE EXTINGUISHERS?

Yes

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* 13. Do you service SYSTEMS?

Yes

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* 14. Do you service ALARMS?

Yes

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* 15. Do you service SPRINKLERS?

Yes

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* 16. Do you service E-LIGHTS?

Yes

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* 17. Do you sell FIRE HOSE?

Yes

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* 18. What is the best time to contact you?

Morning

Afternoon

Evening

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* 19. Would you like to enroll your technicians to receive access to the new Brooks Compliance Guide App,
newsletters, educational information, and code updates? (Free copies of the printed compliance guide are also available; let your account manager know if your technicians want the printed version).
If you want your techs to receive these materials please fill out the following information:
(Add information for additional techs in an email to your Account Manager.)

Example:
Name: John Smith
Email: jsmith@abc.com
Cell Phone: 800-123-4567
Tech Specialties: Portable Extinguishers

1. Name

1. Email

1. Cell Phone

1. Tech Specialties

2. Name

2. Email

2. Cell Phone

2. Tech Specialties

3. Name

3. Email

3. Cell Phone

3. Tech Specialties

4. Name

4. Email

4. Cell Phone

4. Tech Specialties

5. Name

5. Email

5. Cell Phone

5. Tech Specialties

6. Name

6. Email

6. Cell Phone

6. Tech Specialties

7. Name

7. Email

7. Cell Phone

7. Tech Specialties

8. Name

8. Email

8. Cell Phone

8. Tech Specialties

9. Name

9. Email

9. Cell Phone

9. Tech Specialties

10. Name

10. Email

10. Cell Phone

10. Tech Specialties

11. Name

11. Email

11. Cell Phone

11. Tech Specialties

12. Name

12. Email

12. Cell Phone

12. Tech Specialties

13. Name

13. Email

13. Cell Phone

13. Tech Specialties

14. Name

14. Email

14. Cell Phone

14. Tech Specialties

15. Name

15. Email

15. Cell Phone

15. Tech Specialties

Question Title

* 1. Please provide the following information (Each of these 5 fields requires an answer).

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* 2. Please provide the following additional information.

Question Title

* 3. Website:

Question Title

* 4. Please check the quality of service Brooks currently provides.(1 being extremely poor; 5 being excellent)

Question Title

* 5. Do you “will-call” (pick up) orders from your other suppliers?

Question Title

* 6. What new products would you like to see Brooks supply?

Question Title

* 7. What services could Brooks offer to help your business run smoother?

Question Title

* 8. Would you be interested in attending or sending your technicians to one of Brooks Emergency Light and Exit Sign Classes?

Question Title

* 9. How do you prefer to buy product? Please check all that apply.

Question Title

* 10. What other wholesalers do you buy from?

Question Title

* 11. What distributorships do you have?

Question Title

* 12. Do you service FIRE EXTINGUISHERS?

Question Title

* 13. Do you service SYSTEMS?

Question Title

* 14. Do you service ALARMS?

Question Title

* 15. Do you service SPRINKLERS?

Question Title

* 16. Do you service E-LIGHTS?

Question Title

* 17. Do you sell FIRE HOSE?

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* 18. What is the best time to contact you?

Question Title

* 4. Please check the quality of service Brooks currently provides.
(1 being extremely poor; 5 being excellent)