Distributor Questionnaire

Please complete this questionnaire as thoroughly as possible so that full consideration can be given to your suitability. The information provided will be treated as strictly confidential.

Contact Form

Please fill in your details below and we will contact you as soon as possible

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Contact Information

Contact Name:*

Position:*

Company Name:*

Company Address:*

Country:*

Telephone:*

Fax:*

Email:*

Website:*

Company Statistics

Year Company Established:*

Company Type:*

Turnover This Year:*

Turnover Last Year:*

Geographical Area of Coverage:*

Employees (total):*

Employees (outside sales):*

Employees (inside sales):*

Employees (technical/service):*

Employees (other):*

Company Activity

Your Company's Main Activity:*

Please list the company names and type of product you currently distribute

Company Name - Company 1:*

Country - Company 1:*

Turnover Last Year - Company 1:*

Company Name - Company 2:*

Country - Company 2:*

Turnover Last Year - Company 2:*

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When you have completed the form, please click the Send Details button ONCE to send