Name:                   Title:       
Address:           County:
Address 2:
City:              State:      Zip:     Country:

Contact Phone:   Fax:   E-Mail:

Please have representative/dealer contact me via: Phone Fax E-Mail U.S. Mail No preference.

   I am interested in becoming an independent, authorized Shenango sales representative / contractor

Proposed Building:

Size:  ft. wide   ft. long   ft. high

For Use As:  Industrial Commercial Agricultural Storage Garage Church Other

Additional Comments:   

How did you learn of Shenango and our website: Search engine (like Yahoo!) Link from another page Customer referral / word of mouth Trade show Advertisement Dealer Referral Thomas Registry Other