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Distributor Sign-Up Form

- Please fill out this form completely before submitting.

Contact Name:
Position of Contact:
Alternate Contacts:
Telephone:
Cell:
Fax:
Company Name:
Physical Address: (Street)
(City, State, ZIP, & Country)
Mailing Address:
(if different)



Territory of interest:
Market of interest:
Market specifics:



Background Information:

1. Year company founded


2. Turnover/Sales ($)


3. # of employees


4. # of sales people


5. # of service people


6. Current products sold


7. Type of company (Rep/product sales/consulting etc.)


8. Type of customers (machining factories, food industry, paper industry, garages...)


9. Sisters company(in country, outside)




Interview Information:

1. Are you willing to set-on a demonstrator?YesNo

2. Are you willing to stock a product?YesNo

3. How many of your customers have parts washer already (%)?


4. How many parts washers does this represent (#)?


5. How do you intend to penetrate the market?


6. What do your sales people know about parts washing?


7. Has solvent been banned in your proposed territory or when will it be banned?


8. What about competitors for this technology in your area?