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Corporate
Corporate
Corporate
Corporate
Stephen M. Dimond, CEO
1503 Near Thicket Lane
Stevenson, MD 21153
 phone: 410.653.6560
fax: 410.484.4261
info@SDimondAssociates.com

Principal Information Request

Please complete this fact sheet and submit to the region(s) of your choice. This is not intended as an endorsement by S. Dimond & Associates of your firm or its product.

Note: red indicates required fields.

 
Company Name:
Email Address:
Address:
City:
State:
Zip Code:
Phone:
Fax:
Contact Name:
Product Name(s):

Please briefly tell us about the products for which you seek representation, including any information that will show S. Dimond & Associates your products' ability to sell in the marketplace and return a profitable "bottom line" if we were to represent you:

 
Please tell us a little bit about your company, including how long you've been in business, whether you are private or public, etc.:

 
What parts of the USA are you considering for coverage by the sales agents?

All Mid Atlantic
West New England
Rocky Mountain South West
Mid West South East
New York


Any other comments or questions?