New Potential Distributor Form

We welcome your interest in joining our team. To assist us in evaluating your request, please fill out the following form that will be sent by email:

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):