Reseller/Distributor Application

* Marked fields are required.

Name:*E-mail Address:*Your Position or Title:*Phone Number:*Website:*Company Name:*Trading Name (if different):Year business founded?:*DUNS Number:Number of Locations?:Number of employees:Address 1:*Address 2:City:*State/Province:Zip:*Country:*Are you applying to be a stocking distributor? (Please select all that apply):*

Reseller - Not Stocking
Distributor – Not Stocking
Distributor - Stocking
Other (describe below)

What is your business type? (Please select all that apply):*

Retail Store
Dealer
Wholesale Distributor
Other (describe below)

What types of products do you currently sell?:*
Do you currently sell Temperature Measurement Equipment?:*Do you currently sell Calibration/Metrology Equipment?:*If you indicated yes above, what kinds of products do you sell?:*
What area/region/territory do you market and sell to the most?:*List the top three products which are currently sold by your company:Which of our products are you interested in selling?:*What types of products do you currently sell?:*
How do you plan to market and display our products?:*Anticipated initial order size? ($USD):*
Customer and Vendor Trade References:

Reseller Certificate (required for US):

W9:

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Additional Comments: