Distributor Application Form Business Name Business Location Primary Territories Contact Name Contact Email Contact Phone Accounts Payable Contact Name Accounts Payable Email Accountant Phone Have you carried MIT 45 before? YES NO Do you currently carry MIT 45? YES NO How did you hear about us? Referral Request Ad Tradeshow Other Tell Us More What is your primary mode of sales? Cash & Carry In-House Sales Jobbers Sub-Distribution Other How many in-house sales members do you have? Do you have an ideal shipping / freight company? YES NO What is your ideal margin? Which of our product lines are you interested in? MIT 45 Gold MIT 45 Silver Bali Gold Maeng Daddy Super K Sacred Journey Warehouse shipping address. Do you need a liftgate? YES NO What is your anticipated monthly volume with our product? $5,000 - $9,999 $10,000 - $19,999 $20,000 - $29,999 $30,000 - $39,999 $40,000 - $49,999 $50,000 - $99,999 $100,000 - $400,00 $500,000 - $750,000 $1,000,000+ Please list 3 refereces of other MANUFACTURERS you deal with. About how many accounts do you service? What accounts do you currently service? Convenience Stores Smoke Shops Vape Stores Adult Stores Nutritional Stores Wholesale / Distributors Online Other How long has your company been in business? How many SKUs do you distribute? What is the most important thing to you when you start doing business with a new vendor? What is your competitive edge? Would you be interested in becoming a pilot distributor for our new products? YES NO Submit
