DIEM Duroil International Distributor Application Form

Thank you for your interest, this form is designed to help us get to know you better. We are looking forward to working with you and we hope to establish a business relationship.

MINIMUM REQUIREMENTS TO QUALIFY

If your company wishes to qualify as a DIEM Duroil distributor, we request that you have the following:
1. An established channel of distribution appropriate for this type of product line
2. Staff or manpower adequate to service the specified territory
3. An infrastructure for ordering, warehousing, and shipping
4. Resources to adapt marketing and promotional material
5. Familiarity with export/import regulations pertaining to the territory
6. An approved business plan for developing the territory
7. Sufficient capitalization to meet the business plan objectives

EXCLUSIVITY
All distribution agreements are presently on a non-exclusive basis. Final exclusivity will be assigned on a performance basis.

*Name:
(Full name as Passport)

*Company:

*Address, City:

*State:

*Postal Code:

*Country:

*Telephone:

Fax:

*Email:

*Company Website:

*Requested Territory (Country, Region and City):
Please specify the territory you are applying for and include the principal region and city within that territory. Be specific about your information.

*Current Channels of Distribution:
Whom do you presently sell to?

*Competitors or Market Saturation
Are there any other products similar to DIEM Duroil in your market?

*Products Currently Distributed:
What products do you presently distribute? Any possible conflicts?

*Business Competition:
Who are you largest competitors? How would you rank yourself in size and what is your uniqueness?

*Current Size of Business:
How many people do you employ? What is your approximate annual sales (in US$)?

*Customs and Tax:
Are you familiar with all the customs and tax regulations pertaining to the territory?

*Marketing and Promotion:
Do you have your own resources for translating and adapting basic marketing materials for your own markets? It is our expectation that distributors produce marketing materials in the language(s) of their country/territory.

*Financial Capability:
Kindly indicate the amount or range of capitalization that you could make available for this business opportunity.

*Enter Security Code

*Required

We sincerely appreciate the time and interest you have taken in completing this application and look forward to communicating with you. As an applicant, we are limited to the amount of information we can provide you at this time. More in-depth and technical information will be provided to qualified distributors upon request. Please allow several days for us to review your online application.

We acknowledge and respect that you are submitting this application in strict commercial confidence. We agree not to disclose any of its contents to any other company or individual outside of our company without your expressed approval.