International Sales

Bolded fields are required.

Agent Qualification Form

Name:

Company/Organization:
Address:
Address 2:
City:
State/Province/Region:
Country:
Postal Code:
Fax Number:
Phone Number:
E-Mail:
Web site:
President/Manager/Director:
Daigger Contact:
Annual Sales (US $): $
No. of Sales Representatives:
Does your company produce its own catalog?

Please list the regions where your sales activity is concentrated:

Please list products/manufacturers you are currently importing:

Please list products/manufacturer you are looking to import:

Please list three trade references, including contact and phone number:

Bank Address and phone number:

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