Dealer application

Company Name: *

Company Address: *

Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip CodeCountry

Phone: *

-
Area Code	Phone Number

E-mail: *

Fax:

Honey Product Import Permit:
Do you have honey product import permit? *

Yes

Principal officers or owners:

Business Owner/Officer Name: *


Title	First	Last	Middle

Job Title: *

MORE ABOUT YOU

It would also be helpful to know about your own qualifications and why you feel they are appropriate for representing Borneo Acacia. *

MORE ABOUT YOUR COMPANY

Describe your company`s major business activities:

SIZE OF BUSINESS

Can you tell us about the size of your business - How many people do you employ, what are your approximate annual sales (in USD)? *

WAREHOUSING

Do you have your own warehousing, packing and shipping facilities? Please describe. Borneo Acacia products must be kept in a clean, secure, temperature controlled area: *

YOUR SALES FORCE

Please tell us a little about your representatives and their qualifications to sell a product like Borneo Acacia which territories do each presently handle? *

PRODUCTS PRESENTLY DISTRIBUTED

What products do you presently distribute? Are there any possible conflicts? *

CAPITALIZATION

Could you please indicate the amount or range of capitalization that you could make available for this business opportunity? Our concern is that you will be able to finance rapid inventory growth during the first three years.
*

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