Distributor Application Form

Thank You For Your Interest In Becoming A Distributor Of RESTOCK PPE Products.

Please Fill Out The Distributor Application Form Below And A RESTOCK PPE Team Member Will Reach Out To You Shortly.

Once your account is approved, you will receive a notice to the e-mail address you provided on your Distributor Form. The Distributor Agreement will contain information about our pricing margins and ordering process.

Distributor Application Form

BUSINESS CONTACT INFORMATION
COMPANY NAME:*
PRIMARY CONTACT NAME*
BUSINESS TRADING NAME:
MANAGING DIRECTOR(S):
OWNER(S):
PHONE*
FAX*
MOBILE*
Email*
Website
FEIN:*
SOCIAL MEDIA:
BILLING ADDRESS:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
SHIPPING ADDRESS (IF DIFFERENT FROM BILLING ADDRESS):
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
COMPANY BACKGROUND:
NUMBER OF EMPLOYEES:
NUMBER OF YEARS DISTRIBUTING PPE:
PLEASE DESCRIBE YOUR COMPANY HISTORY: (YOU CAN INCLUDE A LINK IF YOU HAVE HISTORY ON YOUR WEBSITE.)
YOUR CURRENT TOP SELLING PPE PRODUCTS:
ACCOUNTS PAYABLE CONTACT NAME
Email
Phone
SALES MANAGER NAME:
Email
Phone
CURRENT ANNUAL SALES (IN USD):
AREAS OF SERVICE ( LIST ALL STATES AND COUNTRIES)
DESCRIBE YOUR DISTRIBUTION NETWORK (HOW MANY SALES REPRESENTATIVES, ACCOUNT MANAGERS, HOW MANY AGENTS, DIRECT TO RETAIL, SUB-DISTRIBUTORS ETC):
PURCHASING PLAN
WHICH PRODUCTS ARE YOU INTERESTED IN DISTRIBUTING?
EXPECTED OPENING ORDER AMOUNT:
ESTIMATED DATE YOUR FIRST ORDER WILL BE PLACED:
HOW MANY ORDERS PER YEAR DO YOU ANTICIPATE?
PAYMENT TERMS
REQUESTED TERMS (REQUIRES CREDIT APPLICATION):*
DISTRIBUTOR DECLARATION
The above information I have provided is true and correct at the time of submission. I understand that this form is not a contract for distribution with Restock PPE. I understand that this application will be assessed and I will be contacted by a representative of RestocK PPE and informed of the outcome.
NAME:*
TITLE:*
Date

Thank You For Your Interest In Becoming A Distributor Of RESTOCK PPE Products.

Please Fill Out The Distributor Application Form Below And A RESTOCK PPE Team Member Will Reach Out To You Shortly.

Distributor Application Form

BUSINESS CONTACT INFORMATION

BILLING ADDRESS:*

SHIPPING ADDRESS (IF DIFFERENT FROM BILLING ADDRESS):

COMPANY BACKGROUND:

PURCHASING PLAN

PAYMENT TERMS

DISTRIBUTOR DECLARATION

More Details

Let’s Connect

Call or Write Us

Follow On Social Media

Thank You For Your Interest In Becoming A Distributor Of RESTOCK PPE Products. Please Fill Out The Distributor Application Form Below And A RESTOCK PPE Team Member Will Reach Out To You Shortly.

Distributor Application Form

BUSINESS CONTACT INFORMATION

BILLING ADDRESS:*

SHIPPING ADDRESS (IF DIFFERENT FROM BILLING ADDRESS):

COMPANY BACKGROUND:

PURCHASING PLAN

PAYMENT TERMS

DISTRIBUTOR DECLARATION

More Details

Let’s Connect

Call or Write Us

Follow On Social Media

Thank You For Your Interest In Becoming A Distributor Of RESTOCK PPE Products.

Please Fill Out The Distributor Application Form Below And A RESTOCK PPE Team Member Will Reach Out To You Shortly.