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HSME Distributor Application Form

This document is a distributor application form for a company seeking to become an authorized distributor. It requests information in three key areas: [1] Company Information including details like business name, address, licenses, website, number of employees; [2] Sales Performance including past and projected sales numbers in various industries; [3] Contact Persons including names, titles, and contact details of primary and alternative contacts. The applicant certifies the accuracy of the information and authorizes the company to verify it.

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Raidah Salwa
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63 views2 pages

HSME Distributor Application Form

This document is a distributor application form for a company seeking to become an authorized distributor. It requests information in three key areas: [1] Company Information including details like business name, address, licenses, website, number of employees; [2] Sales Performance including past and projected sales numbers in various industries; [3] Contact Persons including names, titles, and contact details of primary and alternative contacts. The applicant certifies the accuracy of the information and authorizes the company to verify it.

Uploaded by

Raidah Salwa
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Distributor Application Form

Company Information

Company Name

Date of Establishment Type of Organization

Business license No. VAT No.

Website E-mail Address

Telephone No. Fax No.

Company Address
Zip Code

Directors / Managers Human Resource

Sales & Marketing Purchasing


Number of Employees
Engineers Logistics

Quality Control Others

Office Area m² Warehouse Area m²

Territory and Particular Industry "please state which region/country and particular industry you are applying for"

Region / Country Particular Industry

1) / 1)

2) / 2)

Sales Performance

2022 2023 (forecast)


Total Sales
$ $

In Oil & Gas In Petrochemical In Power Plant In Laboratory Others


Percentage of Sales
% % % % %

Your Sales Reference "please list the top brands which you've been dealing with"

Distributorship "please tick √"


Brand Name Period of dealing with Main Products Territories or Industries
Exclusive Non-Exclusive

1)

2)

3)

4)

Your target sales for HSME products

First 6 months $

First 12 months $

Contact Persons

Main Contact Person Alternative Contact Person

Full Name Full Name

Title Title
E-mail Address E-mail Address

Telephone No. Telephone No.

I hereby certify that all the information provided by me in this application is correct to the best of my knowledge and I authorize HSME Corporation

to investigate and verify the information I have provided herein.

Signature / Company Stamp Date

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