Request for Representation

Individual Applicant:

Full Name*

National ID Number*

Place of Birth

Date of Birth

Day

Month

Year

Father's Name

Mobile Number*

Email Address

Residential Address and Phone*

Company (Legal Entity):

Company Name*

CEO Name

Registration Number*

Phone*

Economic Code (Tax ID)*

Address and Postal Code*

Office Details*

Owned
Rented

Area (m²)*

Office Location*

Inside the city
City outskirts

Warehouse Details*

Owned
Rented

Area (m²)*

Warehouse Location*

Inside the city
City outskirts

Warehouse Address and Location Sketch

Street Address Address Line 2 City State / Province / Region

How long have you been engaged in the distribution and sale of food, detergent and hygiene products?

Type of Payment Guarantee:

Bank guarantee
Property collateral

Distribution, Staff and Software Resources:

Distribution fleet:

Number of Pickup Trucks

Number of Trucks and Light Trucks

Staff:

Sales Staff

Distribution and Warehouse Staff

Finance and Administrative Staff

Sales and Accounting Software

Provinces and Cities Covered

Distribution Method

Wholesale
Retail

Number of Customers

Wholesale
Retail

Please list the companies and manufacturers you currently represent: