International Distributor Company/Business Name **Company/Business Address ** Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Company/Business Website *Company WebsiteIs Your firm a Public or Privately Held Company? **PublicPrivateYear Established (Number of Years your Company has Been in Business): **List or Attach a List of all Countries where your Company Does Business. Which of the Following Describes your Distribution Channels: **ConsumerProfessional* Small Chains & Independents Big Box Retailers eRetailers Direct to Customer Club Retail Consumer Shows Multi-Level Marketing (MLM) * Hospital Government Doctor and Dentist Offices Current Notable Dealers, Retailers, and Sales Channel Partners with Projected Annual RevenueName:Estimated Yearly Sales Volume in Units:Estimated Yearly Sales Revenue:Years Partnered: Estimated Current Yearly Revenue for the CompanyEstimated Current Yearly Revenue for the Company:*Primary Contact for the Business:Name*Title*Phone*Email* List Executive Officers of your Company:President or Chief Executive OfficerName*Phone*Email* Chief Operations OfficerName*Phone*Email* Chief Compliance OfficerName*Phone*Email* Head of SalesName*Phone*Email* List Key Contacts for your Company:Legal/ComplianceName*Phone*Email* Sales and MarketingName*Phone*Email* Operations/ShippingName*Phone*Email* Does your Business use Standardized Agreements with its End Clients? *Does your Business use Standardized Agreements with its End Clients?*YesNoDoes Your Company have an Internal team and Procedures for handling Customer Complaints? **YesNoPlease Provide Proof of your Companies Business License or RegistrationPlease Provide a Group Structure or Organizational Chart * This iframe contains the logic required to handle Ajax powered Gravity Forms. Shop our flavors now Cinnamon CloveNanoSilver MouthrinseRated 4.00 out of 5 $24.99 Winter MintNanoSilver Mouthrinse $24.99 Honey SweetNanoSilver Mouthrinse $24.99 Cool PeppermintNanoSilver Mouthrinse $24.99 Natural Pet Dental & Immune Support Drops (Large - 4 oz) $24.99 Ph Testing Kit $0.00
