Distributor Request Form

Prospective Business Partner Questionnaire.


Company Name: *
Company Address: : *
Phone: *
-
E-mail: *
Fax:
Company Organization: *
Date organized: *
 /  / 



Principal officers or owners:

Name: *
Title: *
Home Address:



MORE ABOUT YOUR COMPANY
Describe your company`s major business activities: *


MORE ABOUT YOU
It would also be helpful to know about your own qualifications and why you feel they are appropriate for representing Memoscent *


SIZE OF BUSINESS
Can you tell us about the size of your business -
how many people do you employ, what are your approximate annual sales (in USD)? *


WAREHOUSING
Do you have your own warehousing, packing and shipping facilities?
Please describe. Memoscent products must be kept in a clean, secure, temperature controlled area: *


YOUR SALES FORCE
Please tell us a little about your representatives and their qualifications to sell a product like Memoscent which territories do each presently handle? *


TECHNICAL
Do you have your own service facility and workshop for repairs and overhaul of products?
If no, do you contract with an outside service contractor? *


PRODUCTS PRESENTLY DISTRIBUTED
What products do you presently distribute?
Are there any possible conflicts? *


CAPITALIZATION
Could you please indicate the amount or range of capitalization that you could make available for this business opportunity. Our concern is that you will be able to finance rapid inventory growth during the first three years. *


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