Agent / Distributor Questionnaire

Simply fill in the form and submit your request or you may download this form in a Microsoft Word format by clicking HERE, then fax it to us. (Asia fax number: 65-6841-5988.)

Company Information

Company Name:
Company Address:
City, State & Zip:
Country:
Company Phone:
Company Fax:
E-Mail:

Officers:

President:
Vice Pres.:
General Mgr.:
Sales Mgr.:
Finance Mgr.:
Service Mgr.:

Products You Sell Exclusively

1.): % of Sales:
2.): % of Sales:
3.): % of Sales:

Products You Sell Non-Exclusively:

1.): % of Sales:
2.): % of Sales:
3.): % of Sales:

Sales Promotion

Are you willing to share sales promotion expenses?