New Distributor Application Form

Business Contact Information

Company name

VAT or CNPJ or Tax No.

Country

City

Mailing address

Office Tel

Fax

Website

Email

Managing Director(s)

Owner(s)

Your Name

Phone

Job Title

Email

COMPANY BACKGROUND

Number of employees:

Years in business:

Total annual sales in USD:

Size of warehouse(Sq meters):

Number of years distributing ATGs:

Percentage of business related to ATGs

Which brand ATG

Yearly sales volume of ATG

What other filling station equipment you are distributing?

How many people of your ATG service team?

Do you need native language brochure? Which language?

MARKETING information

Which trade fairs do you exhibit at?

Other marketing activities you undertake (e.g. in store promotions, online advertising):

Requirement on products

Console Model

Estimated yearly demand in quantity

Probe

Estimated yearly demand in quantity

SHIPPING INFORMATION

Seaport name

Airport name