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

Do you have outside sales representatives?
If yes, how many?

Catalog
Do you produce a catalog?
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: