• Company Name and DBA if applicable *
• Headquarter Location (complete address): *
• Name *
  First Last
• Position
• Email *
• Company’s phone number: *
• Website
• Location *
• Accounting Manager contact information (name, email address and phone number)
• Sales Manager contact information (name, email address and phone number)
• Number of sales representatives:
• Purchasing Manager contact information (name, email address and phone number)
• Areas of distribution you currently cover *
• Type of items you currently distribute *
• Are you interested in the full line of products or just a few items? *
  The full line of products

  Just a few items
• What is the nature of your business (Broadliner, Paper, Specialty Foods…)?: *
• If you wish to import our products, do you have a freight forwarder in the US? If yes, in what state?
• Sale certificate (attachment) *