Distributor Application Form

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SANKOM Distributor Application Form

Company’s Name:
Contact person:
Country:
City:
ZIP Code:
Address:
Phone:
Fax:
E-mail:
General company's information
Numbers of employees:	1-10 10-20 20-50 50-100 100 and more
Years of company establishment:	1 year or less 2-5 years 5-10 years 10 years and more
Anticipated volume next year:	USD EUR 100,000 – 200,000 200,000 – 500,000 500,000 – 1,000,000 2,000,000 and more
Marketing information
Possible / proposed distributorship network (countries / areas):
What percent of your company's sales are to the following channels?
Consumers:	%
Pharmacies:	%
Drugstores:	%
Retailers:	%
Wholesalers:	%
Fitness Clubs:	%
Other:	%, please specify:
Any other information you wish to provide:

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