B E    A U T H O R I Z E D    D I S T R I B U T O R
*First Name:
 
*Last name:
 
*Occupation:
*Organization:
Commercial area:
*Address:
   
*City:
*Country:
State:
Zip Code:
 
*Phone number:
Fax:
*E-mail:
Web o URL:
   
*Industry Segment :
Marketing
Sales
Distribution - Logistic
e-commerce
Business Intelligence
Banking - Finance
Health
Cadastre
Services
Engineering
Government
Real property
Other:             Specify:
 
*Banking references :
Reference - Address - Phone - Email

 
*Commercial references :
Reference - Address - Phone - Email

 
*Employees' number:
*Annual sales - US $:
 
Number of actual and active clients:
 
Number of clients attended in all company history:
 
*Products you want to distribute:
Other:
How did you know about us?:
 
*What are the reason you want to be our distributor?:
 
Additional comments:
   
 
 
 

 

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