Distributor Application

Distributor Application
Company Name*
Contact Name*

First NameLast Name
E-mail*
Website

Retail Operations
Number of Retail Locations
How many locations would stock WorkSafe USA’s products?

Online Sales
Do customers place orders on your website?

YesNo
If yes, what is your percentage of online sales?
Outside Sales

Do you have outside sales representatives?

YesNo
If yes, how many?

Catalog
Do you produce a catalog?

YesNo
If yes, how often?
Size of mailing list?

Marketing
Describe your target market including geography & industry
What do you estimate your unit sales for each product to be in a 12 month period?
Dump-Lok
No-Jack
Cab-Lok
Wing-Lok
Should be Empty: