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Agency Application Form

 

APPLICANT INFORMATION

 

Company Name

Name of Owner

Mailing Address

City

Country

Tel Number

GSM Number

Fax Number

E-mail

Web Site

Years in business

Do you have sufficient financial resources to conduct the business?

Yes

No

Are you willing to dedicate 2 marketing personnel to introduce the products to your territory?

Yes

No

Are you willing to dedicate a technician to install equipment and service your customers?

Yes

No

What is your channel of distribution?

How do you plan on finding customers?

Name of person completing the form:

Designation:

GSM

Email

AUTHORIZED PERSONNEL

 

(Personnel listed below are authorized to access, change, or receive information pertaining to this account).

Name

Tel.

email

Name

Tel.

email

 

   

 

 

 

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