DISTRIBUTOR APPLICATION FORM

Many thanks for your interest in Movex Innovation. Please fill in all the fields below and a representative will be in contact with you soon.
APPLICANT CONTACT INFORMATION
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Name

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Job Title
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Email
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Company Statistics
Year Company Established
Company business type

ManufacturerDistributor/Sale agentRe-Sale AgentSystems IntegratorOther
Turnover this year (USD)
Turnover last year (USD)
Geographical Areas of coverage
Employees (total)
Employees (outside sales)
Employees (inside sales)
Employees (technical/service)
Company Activities
What is your Company's main activity?

Marketing
What are the principle markets for your current products?
Who would you consider ascompetitors for MOVEX INNOVATION products inyour marketplace?
How do you market your current range of products?
What will your company do to market and sell MOVEX INNOVATION products?
Would you appoint a MOVEX INNOVATION specialist or product manager?

YesNoMaybe
Do you belong to any trade organizations? If yes, please specify.
Do you exhibit at trade shows? If yes, please specify.

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 Movex Innovation. I understand that this application will be assessed and I will be contacted by a representative of Movex Innovation and informed of the outcome.
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APPLICANT CONTACT INFORMATION