Name:


Email:


Country(s) of interest:


Brief Description of your interest, including current product portfolio:

Complete Mailing Address

Street Address:


City / State / Zip Code:


Country:


Daytime Telephone Number:

Distributor Selection Questionnaire

Company Name:


Owner/President:


Main Office Address:

Telephone Number:


Fax Number:


Website:


Brief Company Profile:

Are you a member of any trade/professional associations?:


We will highly appreciate if you can also enclose a CV of the people who will be responsible for sales of Oculus Innovative Sciences products.

Products your organisation currently sells

a) In-house manufactured / assembled:


b) Distributions:

Territory

Please indicate the zone, state, country, or city where you intend to focus your promotion:

Do you have a formal procedure to follow up with prospective customers and quotations?
Yes/No……….Describe briefly.

Describe your method to assign sales person time according to product lines:

Personnel

Number of offices your company has:

List cities, states, zones, sales people and total personnel in each office:

Sales

Total sales of your company during the last 3 years. $ or local currency.

If these sales are in different product types please specify.

Describe the target markets where your products are sold:

Main Competitors & their Market Share:

Main Local Suppliers:

Additional information to support your application: