*(denotes required field)

E-Mail Address: *

Company Name: *

Contact Name: *

Address: *

Website: *

How long have you been in business? *

What methods do you employ for getting products to market (catalog, sales people, etc)? *

Whose waxes do you currently sell? Do you buy directly from the manufacturer or through a distributor(s)? Which distributor(s) do you currently deal with? *

Which products are you interested in representing (be specific) *

Where do you intend to sell our products (If outside the U.S., please be specific) *

Why are you interested in our waxes? *

How large would a typical order be, and how frequently do you anticipate placing orders? *

Will you maintain a current inventory of products you purchase from Freeman to service your customers, or do you plan to service them primarily on a drop-ship basis? *

What is the current market price for the competitive waxes that you intend to displace with our products? What price do you require from Freeman to accomplish sales goals? (Be specific, this information is REQUIRED for further consideration of this application). *

Freeman Mfg. & Supply Company believes in supporting our distribution partners wherever possible. As such, we place great emphasis on organic growth and protecting business already established by existing dealers. Failure to abide by this policy could result in termination of distribution authorization. If you are selected to become an authorized dealer, do you agree to adhere to this policy? *

In order to comply with current United States export laws governing international trade, Freeman Mfg. & Supply Company will not ship products to Cuba, Iran, North Korea, Sudan and Syria. As a dealer of our products, you must also agree that you will NOT make our products available for sale in these countries. Do you agree to adhere to this policy (you will be asked to sign an agreement stating such before receiving you first shipment)?

Yes

No