Distribution Requests

Please complete this questionnaire as thoroughly as possible so that full consideration can be given to your suitability.

 

Please complete the form below

Contact Information
Contact Name *
Contact Name
Company Address *
Company Address
Phone *
Phone
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Company Information
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Marketing
Do you have your own resources for translating and adapting basic marketing materials such as literature for your own markets?
Our Products
Customs
Are you familiar with all the customs and tax regulations pertaining to the territory?
Other Information
References
Company 1 Address
Company 1 Address
Company 1 Contact Name
Company 1 Contact Name
Company 1 Phone
Company 1 Phone
Company 2 Address
Company 2 Address
Company 2 Contact Name
Company 2 Contact Name
Company 2 Phone
Company 2 Phone