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Distributor Application Form

DISTRIBUTOR INFORMATION


Distributor Name:
Date:
Address:
City:
P.O. Box
Country
Phone:
Fax:
Email:
Company Web Address:


Principal Contact And Title:
Principal Contact’s Email:
Purchasing Contact:


REFERENCES AND BANKING INFORMATION


Please provide three trade references (if available):


DISTRIBUTION SERVICE


Number Of Years In Business:
Number Of Sales Employees:
Annual Revenue:
Territory:


Please state how you plan to market and promote Petromax products:
Please list the trade shows your company attends each year:
How much Lubricants do you expect to sell in the next twelve months?