Distributor Application

List of Additional Branch Offices

Business Structure:  Corporation,    Partnership,    Proprietorship,    Other (Explain)

Name

Name

Name

Written purchase orders required? Yes     No

Suppliers of major product lines 1.
2.
3.

Geographic area

Please indicate the top three markets that you serve and the % of total sales that each market represents to your business:

Methods used to reach markets (Check all that apply):

What tradeshows do you regularly exhibit or attend ? Exhibit or Attend                    
                   
                   

Competitors :

Please identify any products you now carry that you feel might be competitive with Indumar’s product lines:

How did you first learn about Indumar’s products?

Submitted by: (Name & Title)