Your Email: Primary (bill to) Location
Company:
Address:
City:
State:
Zip Code
Country:
Phone:
Fax:
E-mail:
Web address:
Tax ID #:
Owner:
General Manager:
Sales Manager:
Primary (ship to) Location
Company:
Address:
City:
State:
Zip Code
Country:
Phone:
Fax:
E-mail:
Web address:
Tax ID #:
General Manager:
Sales Manager:
Are there multiple branches interested in distributing Drader welding equipment and supplies? (If yes, use a separate sheet and record (bill to & ship to) info for each branch).
Your Business
How long has your company been in business as a distributor?

Represent (list companies)	Type of Product	Contact	Phone

Geographic coverage of your company
Which type of industries does your marketplace comprise?
How many sales people do you have that will concentrate on Drader products?
Are you or your employees knowledgeable about plastic welding and processing? Please describe the experience:
Why do you want to distribute Drader products?
How do you plan to sell the Drader Product line? (%)

Type of Sales Promotion	Expected % of sales effort
Catalogues & Mail outs
Direct (face to face) selling
Internet
Telephone sales
Other (list)
Other (list)
Expected sales per year (Welders):
How did you find out about Drader?
Person filing this form:
Company:
Date:
Or fax this form to Drader Injectiweld, Inc. Attention: Christie Simpson, Account Representative FAX: +1 (780) 440-2244 --- Phone: +1 (780) 801-2238 E-mail: csimpson@drader.com