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About PBP | Contact Us | Rep/Distributor Request Form
Agent / Distributor Profile
Company Name
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Street Address1
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Street Address 2 :
City
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State/Province
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Zip/Postal Code
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Country
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E-mail Address
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Phone Number
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Fax Number
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Facility is
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Select Facility
Headquarters
Manufacturing Site
Warehouse
Research Center
Service Center
Product Showroom
Company Contacts
Chief Executive :
Title :
English:
Speak
Write
Sales Manager :
Title :
English:
Speak
Write
Service Manager :
Title :
English:
Speak
Write
Other :
Title :
English:
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Write
Company Background
Year Founded :
Number of Employees :
Type Of Ownership :
Select Ownership Type
Corporation
Partnership
Proprietorship
Government
Parent Company :
Subsidiary Names :
Describe Business Activity :
Select Business Activity
Commision Agent
Distributor
Wholesaler
Trading Company
Purchasing Agent
Retailer
Broker
Manufacturer/Producer
Other
Annual Sales in US Dollars :
Range :
Select Range
<$500,000
<$5 million
<$50 million
>$50 million
Company Interests
Why do you want to represent our company?
In which of our products are you interested in?
What quantities and when needed?
In which territory are you interested in representing our product?
Why do you think our product will sell in your market area?
What support would you expect from our company?
Company Facilities in the Market Area
Branch Offices
Manufacturing Sites
Facilities:
Warehouses
Research Centers
Service Centers
Product Showroom
Location of Branch Offices and Number of Representatives
Location of Warehouses
Company and Product Lines Currently Represented
Company Name:
Product Line:
Type of Representative:
Agent :
Dist :
Since Year:
Sales US $:
Company Name:
Product Line:
Type of Representative:
Agent :
Dist :
Since Year:
Sales US $:
Company Name:
Product Line:
Type of Representative:
Agent :
Dist :
Since Year:
Sales US $:
Company Name:
Product Line:
Type of Representative:
Agent :
Dist :
Since Year:
Sales US $:
Do any of the Above Product Lines Compete with Our Products?:
Yes
No
If yes, which products?:
Are Any of the Above Product Lines Complimentary with Our Products?:
Yes
No
If yes, which products?:
Distribution Network
In what geographic location does your company providedistribution?
What is your position in the distribution network?
What distribution channels do you use?
What customer segments do you serve?
Number of Customers?
Payment terms normally offered to customers:
What trade shows do you attend related to our product line?
Why do you believe you will be successful selling our product?
In the initial trial period, will you accept:
Nonexclusive agreement:
Yes
Payment by letter of credit:
Yes
Sales performance objectives:
Yes
Thank you for completing this profile and helping us learn more about your Company.