Regul8 Distributor Questionnaire

Regul8® distribution is an exciting opportunity. We are dedicated to making sure that our distributors are not only passionate, but that they are equipped with all the tools in education, marketing and sales to deliver Regul8's brand message. The company is driven by results, therefore, the individual distributions must represent this on all levels. We look forward to reviewing your application.

Company Name*

Key Contact Name*

First NameLast Name

Email*

example@example.com

Phone Number

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postcode / ZipCountry

Do you currently distribute dietary supplements, wellness, medical or beauty products?*

YesNo

Please list:

Do you distribute anything outside of the above categories?*

YesNo

Please list:

Do you have an existing distribution network of stockists or resellers?*

YesNo

Please detail:

Which territory (state or country) are you interested in applying for becoming a Regul8 distributor?*

What are the main reasons for applying to be a Regul8 distributor?

What is your current staffing structure (in numbers)?

Total staff

Sales/ Account Managers

Administration

Marketing

Warehouse

Other

Please indicate your current turnover per annum (USD):*

Less than $500,000$500,000 - $1,000,000$1,000,000 - $4,000,000More than $4,000,000