DISTRIBUTOR APPLICATION FORM

Be a part of our fast growing Network. We pride ourselves in building strong relations. Join our group of Distributors and get the opportunity to present more options to your customers.

Name / Address

     

Company

 

Address 2

 

Address

 

City

 

Country

 

Postal Code

 

Phone No

 

Fax

 

Email

 

Website

 

Contact person

 

 Designation

 

Email

 

DID

 

 

Distributorship Application:

Company Info

     

Biz Size of company

 1-5       6-10       10-20      20-50      50 and above (Circle one)

Sales Rep (Total)

 1-5       6-10       10-20   20 and above (Circle one)

Inside Sales Rep

 1-5       6-10       10-20   20 and above (Circle one)

Geographical coverage

 (List all relevant states, countries or regions with people on the ground) 

Brands you are currently representing

 (List all brands represented) 

 

 

Products of interest

 

Geographical area(s) of interest

 

Describe your target base (in brief)

 

 

Top 4 customers

1                                                                                    2

 

3                                                                                    4

Marketing Strategies

(in brief)