Lines Wanted
Looking for Lines?
Complete our "Representation Available Ad" form. New ads are posted to the "members" section of our website on the Tuesday after they are received and emailed to our associate membership each week for 30 days. Members are instructed to contact you directly if they are interested. This service is free for Representatives Members.
*Members in good standing receive unlimited ads
**Non Members will be invoiced $100 (postings are pending until invoice is paid)
Sign in to Google to save your progress. Learn more
Contact Information *
Firm Name / Contact Person / Job Title
Firm Address  *
Street Address, City, State, Zip
Phone #  *
Best phone # for contact person listed above
Email *
Website (list N/A if you do not have one)
Reason for Ad Posting  *
List the reason you are posting an ad (ex: looking for new product lines, to fill a new territory)
Firm Type *
Firm History *
Please provide a brief history of your firm
# of Years in Business
Growth and Future Plans *
Please describe your growth history, do you operate on a sales plan or budget, and your plans for growth
Territories covered *
Please mark ALL territories covered by your firm
Required
Prime Market *
Check the top 3 primary markets you serve
Required
Specialty Market *
Check the top 10 specialty markets you serve
Required
Invoicing *
Do you invoice lines?
Certifications *
Payment (non HIRA member) *
I understand that payment is required and that I will be invoiced for $100
*Invoice will be emailed within 24 hrs of receipt M-F.
**Please ad us to your safe senders list - hira@hira.org
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy