Become an International Distributor


Name:
Company:

Email:
Telephone:
Fax:

Address:
(xtra line if needed)

Bldg:
Room Number:
City:
State/Province:
Country:
Zip/Postal Code:

Years in Business:
Business Entity:
Person in Charge of sales and Marketing:
Who are the principals in your organization?
What other companies do you represent?
What is your annual revenue/turnover?
How many sales/marketing people do you have?
What are the top three sales regions for your company?
In what countries would you distribute our products?

Please provide three references from end users:
Ref Name:		Phone Number:

Comments:

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