Local distributor form

Application form local distributor

Please be so kind and fill out the form below.

 

*Indicates required information

Company name:*
   Address:*
   City:*
   Postal Code:*
   Country:*
   Phone* / Fax: Phone:        Fax:
   Email:
   Website:
 
Contact Person       
   Name:*
   Position:
   Email:*
 
Company figures       
   Founded:
   Branch/es:
   Annual turn-over: 2008: €/US$     2009: €/US$
   Number of staff:       
   Technical staff
   (please indicate
   qualification)
   Sales and marketing
   staff
 
Field of activities  
   What industry are
   you in?*
   Reference list
     available?		 Yes:      No:
   What is your main
   sales region?*
       
Please describe your experience and qualifications in selling relevant measurement
and software systems:
Please outline your plan for distributing our products:
Comments:
Please type in the characters you see in the textbox below