Name of your company
Name of contact person
Contact telephone number
How long has your company been in operation
What does your company do
How many staff work for your company
What products / brands your company represents
(or has represented) over the last five years
(indicate exclusivity/non exclusivity and territory):
Does your company provide after sales services ?
How many staff members are there in your sales team?
Which distribution / sales methods are used ?
Why are you interested in representing our company ?
Are you interested in an Exclusive or Non-Exclusive Distribution Agreement ?
Will you commit to sales targets in the Distribution Agreement ?
Will you sign a confidentiality agreement ?
Do you require samples ?
Address and contact person for sample delivery :
Courier company, account number
Thank you for taking the time to fill this in