Application for Distributorship Form

Company Legal Name and d/b/a (if applicable)

Company Address (principle place of business) *

Company Phone Number *

For locations outside of the US and Canada please contact us at [email protected]

Principal Contact Name and Title *

Principal Contact's Direct Phone Number *

For locations outside of the US and Canada please contact us at [email protected]

Principal Contact Email *

Names and Titles of Officers or Owners *

Legal Name and Address of Headquarters or Parent Company (principal place of business) (if applicable)

Geographic Concentration *

Primary Industries Served *

Distributor Type

Industrial

Woodworking

Jewelry

Machine Tools

Primary Product Lines Distributed *