Agent application

Company: owner:
Address: Tel:
Contact: position: Tel:
Month sales: volume Annual sales amount: Capital condition:
Terminal amount: Business area: number of staff:
Brand of the cable distributed:
Status of our product be authorized for dispatch:
Selling Status of our product:
Stock status of our product:
Building Partnerships:
Status of marketing network:
Items need our assistance:
Payment:
Delivery terms:
Other cost:
Other information: