Legal Company Name:
Trading Name (if different):
Company Registration Number:
Date of Incorporation:
Website URL:
Address Details
Filed | Registered Office Address | Headquarters Address | |
|---|---|---|---|
Street Address | |||
Suite/Unit | |||
City | |||
State/Province | |||
Postal Code | |||
Country |
Role | Name | Phone Number | Email Address | |
|---|---|---|---|---|
Primary Contact | ||||
Sales Manager | ||||
Logistics/Ops | ||||
Accounts Payable |
Type of Business:
Wholesaler
Retailer
Value-Added Reseller
Other:
Primary Industries Served:
Total Number of Employees:
Number of Sales Representatives:
Warehouse Facilities:
Total Square Footage/Meters:
Climate Controlled?
Number of Distribution Centers:
Current Geographic Coverage: (List regions/territories)
Tax Identification Number:
Annual Turnover (Last Fiscal Year):
Bank Name:
Currency Preferred:
Credit Limit Requested:
Trade References: (Provide two)
Company | Phone Number | Email Address | |
|---|---|---|---|
Current Portfolio: (List major brands you currently distribute)
Proposed Marketing Channels:
Direct Sales Force
E-commerce / Online Marketplace
Sub-distributors / Dealers
Physical Retail Stores
Competitor Brands: (List any brands you carry that may compete with our products)
I, the undersigned, represent that the information provided above is true and accurate to the best of my knowledge.
I authorize the company to verify the references and financial information provided herein for the purpose of establishing a distributorship.
Authorized Signature:
Form Template Insights
Please remove this form template insights section before publishing.
This section establishes the framework of the business entity.
This is where you move from "who they are" to "what they can do."
Distributors are essentially your primary customers who buy in bulk; therefore, their fiscal strength is vital.
This section identifies the "Product-Partner Fit."
For F&B, this is the most critical technical portion of the template.
Mandatory Questions Recommendation
Please remove this mandatory questions recommendation before publishing.