Distributors Form

Your Company / Business Name:

Your Name:

Your Position / Title :

Phone (include area code):

Fax (include area code):

E-mail:

Address:

City:

Zip:

Country:

in which country/countries do you focus your sales efforts:

How long has your company been in business:

Where do you focus your sales efforts

(e.g. Retail,
Supermarket etc.)

Your approximate annual sales and the number of salespeople:

Which products are you most interested in:

Do you sell other EAS accessories:

if yes, whose products:

Which local or international exhibitions do you attend:

How did you hear about Virginland:

Please provide us with a China based business reference

 (Company Name/ Contact Name/ Phone/ Fax):

Do you buy any other products from China

based companies
(list top 2):