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Distributor Application
Distributor Form
Business Name
Business Location
Primary Territories
Contact Name
Contact Email
Contact Phone
Accounts Payable Contact Name
Accounts Payable Email
Accountant Phone
How did you hear about us?
Referral
Request
Ad
Tradeshow
Other
Tell Us More
What is your primary mode of sales?
Cash & Carry
In-House Sales
Jobbers
Sub-Distribution
Other
How many in-house sales members do you have?
Do you have an ideal shipping / freight company?
Yes
No
What is your ideal margin?
Warehouse shipping address
Do you need a liftgate?
Yes
No
What is your anticipated monthly volume with our product?
$5,000 - $9,999
$10,000 - $19,999
$20,000 - $29,999
$30,000 - $39,999
$40,000 - $49,999
$50,000 - $99,999
$100,000 - $400,00
$500,000 - $750,000
$1,000,000+
Please list 3 references of other MANUFACTURERS you deal with
About how many accounts do you service?
What accounts do you currently service?
Convenience Stores
Smoke Shops
Vape Stores
Adult Stores
Nutritional Stores
Wholesale / Distributors
Online
Other
How long has your company been in business?
How many SKUs do you distribute?
What is the most important thing to you when you start doing business with a new vendor?
What is your competitive edge?
Would you be interested in becoming a pilot distributor for our new products?
Yes
No
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