Application form

Application form

So that we can better understand your company, please take the time to complete this form as thoroughly as possible.

General company information
Legal Company Name (as submitted for tax reporting purposes)
Legal Name*
Other names by which your company is known as in business (Doing Business As)
Other Name
Corporate Headquarters
Address*
Suite/PO Box*
City*
ZIP/Postal Code*
Province/State*
Country*
Web Site*
Company Description
(Please provide a brief description of your company and core competencies) *
How many employees work for your company?
Employees
Do you currently purchase through Distribution? *
Yes No
Company sales data
What was your company's overall sales in the last completed fiscal year? *
Market segmentation
Please specify the geographical areas where your company does business
AFRICA
AMERICAS
ASIA/PACIFIC
EUROPE
MIDDLE EAST
UNITED STATES ONLY
What percent of your overall sales is sold to the following market segments?
Food * %
Beverages * %
Pharmaceuticals & medical products * %
Cosmetics & toiletries * %
Non food consumer products * %
Electrical & electronics * %
Cable, tubes & profiles * %
Plastic & rubber components (non extruded) * %
Automotive, vehicles & transport * %
Other * % Please Specify
Contact information
Application Submitted By (Person to be contacted regarding the program application)
First Name*
Last Name*
E-Mail*
Position/Department*
Address*
City*
ZIP/Postal Code*
Province/State*
Country*
Telephone*
Please enter text in image * Generate a new text

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