Distributor Application

1 Company Information

Company Name

Business Type (Retailer, Wholesaler, etc.)

Business Registration Number

Company Address

Street Address

City

State / Province

Zip / Postal Code

Country

Phone Number

Email Address

Website URL

Social Media Links

2 Contact Information

Primary Contact

Primary Contact Name

Position / Title

Phone Number

Email Address

Secondary Contact (Optional)

Name

Position

Phone

Email

3 Business Overview

Year Established

No. of Employees

Annual Revenue

Business Location(s) (Branch/Offices/Warehouses)

Industries Served

Business Structure

Company Legal Entity

4 Experience & Track Record

Describe company's experience in distributing products

Previous Distribution Agreements/Partnerships (if applicable)

List of Current Brands/Products Distributed

Average Sales Volume per Month (units or value)

5 Distribution Capabilities

1. Products/Services Interested In Distributing

2. Target Market

Industry

Market Segment

Demographics

Geographical Areas of Distribution

3. Warehouse and Storage

Location(s)

Total Storage Area (sq meters)

Inventory Management System

Temperature-Controlled Storage?

Yes No

4. Avg Lead Time for Order Fulfillment

Packaging and Labeling Capabilities

5. Minimum Order Quantity (MOQ)

By Product Category

By Product Type

6 Financial Information

Payment Terms

Prepaid Credit Letter of Credit

Preferred Currency

Payment Method

Bank Transfer Credit Card PayPal Other

Credit Check & Financial Standing

Bank Name

Bank Address

Contact Person at Bank

Annual Revenue (Last 3 Years)

Any Previous Defaults or Payment Issues?

Yes No

7 Legal & Compliance

Trade License Number

Tax Identification Number (TIN)

Other Certifications (ISO, HACCP, etc.)

Licenses to Import/Export (if applicable)

2. Insurance

Liability Insurance Coverage

Product Liability Insurance

Transport/Shipping Insurance

3. Regulatory Compliance

Compliant with local laws regarding product distribution?

Yes No

Any known legal disputes or ongoing investigations?

Yes No

8 Marketing & Sales Plan

1. Sales and Marketing Strategies (How do you plan to promote?)

Marketing Channels

Direct Sales Online Marketing Retail Distribution Telemarketing Other

2. Sales Team Information

Number of Sales Representatives

Sales Team Structure

Experience and Training Provided

3. Promotional Support Required

Marketing Material Product Samples Advertising Support Other

9 References

Reference #1 (Previous Supplier)

Reference #2 (Industry Body)

Terms & Confirmation

I hereby confirm that all the information provided above is true and correct to the best of my knowledge. I understand and agree to the terms and conditions of the distribution agreement upon approval. I agree to provide any additional documents or information as required for due diligence or legal purposes.

Authorized Signature

Name

Position / Title

Date