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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: 		  1-10   10-20   20-50   50-100   100 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 – 200,000
 200,000 – 500,000
 500,000 – 1,000,000
 2,000,000 and more
Marketing information
Possible / proposed 
distributorship network 
(countries / areas): 
What percent of your company's sales are to the following channels?
Consumers:   %
Pharmacies:   %
Drugstores:   %
Retailers:   %
Wholesalers:   %
Fitness Clubs:   %
Other:   %, please specify:
Any other information 
you wish to provide: 
2,243.50 €
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