SANKOM Distributor Application Form

Company’s Name: *

Contact person:

Country:

City:

ZIP Code:

Address:

Phone: *

Fax:

E-mail:

General company's information

Numbers of employees:

1-20

20-50

50-100

100-500

500 and more

Years of company establishment:

1 year or less

2-5 years

5-10 years

10 years and more

Anticipated volume next year:

USD

EUR

100,000 – 500,000

500,000 – 2,000,000

2,000,000 – 5,000,000

10,000,000 - 50,000,000

50,000,000 and more

Marketing information

Possible / proposed distributorship network (countries / areas):

Consumers:

What percent of your company's sales are to the following channels?

Pharmacies:

Drugstores:

Retailers:

Wholesalers:

Fitness Clubs:

Other, please specify:

Any other information you wish to provide: