Questionnaire 21-004: Activities Within Iowa For A Corporation, Partnership Or Llc Page 3

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If yes to items 13 e - h, complete the following information and provide a copy of any hiring agreements:
Name & Mailing Address
Date Hired
Date Ended
________________________________________________________ _____ __________ __________
Type of the soliciting individuals or companies____________________________________________
Name & Mailing Address
Date Hired
Date Ended
________________________________________________________ _____ __________ __________
Type of the soliciting individuals or companies____________________________________________
Name & Mailing Address
Date Hired
Date Ended
________________________________________________________ _____ __________ __________
Type of the soliciting individuals or companies____________________________________________
Name & Mailing Address
Date Hired
Date Ended
________________________________________________________ _____ __________ __________
Type of the soliciting individuals or companies____________________________________________
14. In the state of Iowa, does the company:
Yes
No
Have a warranty on its products (include a copy of the warranty)?
_________
________
Have an office, agency, warehouse, or any other place of business?
_________
________
Pay an employee for the use of part of a home or any other location?
_________
________
Please provide dates and addresses:
________________
____________________________________________________________
________________
____________________________________________________________
________________
____________________________________________________________
15. While traveling in Iowa, did:
Yes
No
How Often?
Employees get involved in warranty matters?
______ _______ __________
Non-employees (dealers, retailers, service facilities, etc.)
get involved in warranty matters on behalf of the company?
______ _______ __________
Non-employees perform warranty repairs on behalf of the company? ______ _______ __________
a. Please explain, in detail, all yes answers:
21-004c (04/04/11)

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