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SINGH DISTRIBUTOR / DEALER / SERVICE AGENT - APPLICATION FORM
(Information of items in * is compulsive)
Please use this form only if you are able to provide most of the data requested below. Otherwise, use the CONTACT US form. Thank you.
Contact Information :
*Company Name :   *Date  (mm/dd/yy)
*First Name :
Middle Name :
*Last Name :
*Title :
*Address Line1 :
Address Line2 :
*City :   *State     
*Zip/Postal Code :  *Country 
*Phone 1 : (countrycode : areacode : phone no)
Phone 2 : (countrycode : areacode : phone no)
Fax : (countrycode : areacode : phone no)
E-mail :
Web Address :
  Key Personnel :
  Principal
*Name :
*Phone : (countrycode : areacode : phone no)
*E-mail :
  Sales Manager
Name :
Phone : (countrycode : areacode : phone no)
E-mail :
  Purchasing Agent
Name :
Phone : (countrycode : areacode : phone no)
Email :
  Other
Name :
Phone : (countrycode : areacode : phone no)
Email :
     
  Business Background
     
*No. Of years in business :
*No. Of years under present Owner :
*No. Of Locations :
     
  List all Locations
Location 1    
*Contact :  *Title     
*Ship to address :
*City :   *State    
*Zip/Postal Code :   *Country
*Phone : (countrycode : areacode : phone no)
*Fax : (countrycode : areacode : phone no)
Location 2    
Contact :   Title     
Ship to address :
City :   State    
Zip/Postal Code :   Country
Phone : (countrycode : areacode : phone no)
Fax : (countrycode : areacode : phone no)
Location 3    
Contact :  Title     
Ship to address :
City :   State    
Zip/Postal Code :   Country
Phone : (countrycode : areacode : phone no)
Fax : (countrycode : areacode : phone no)
     
*Current Regions Covered :
*Group Affiliation :
     
No. Of Employee : Full Time  :
    Part Time :
     
  Please describe type Of business : (* mandatory)
     
  Current Anual sales( in Euros) :
  (Please enter '0' for values that are currently unavailable)
*Quarry Products : Euros
*Recycling Products : Euros
*OEM Sales / Production : Euros

*If any of the products you represent are repaired, serviced, remanufactured or rebuilt, please provide the labor value:  Euros
*Current Product Lines Offered :
     
List all products and brands represented on a direct basis :
     

Current scope of Quarry / Re cycling / OEM machinery sales in your area :

Potential for SINGH BULLET RANGE OF MACHINES in your market area : Euros
     
  E-Business Capabilities In Your Region: (* You must select at least one)
     
ATM    Internet
Online Banking   Other - Describe
     
Other Information :
To facilitate early decision, please provide photographs of your facilities:
Optional, Submissions in reasonable quantities can be mailed as jpeg. files to
     
         
     
 
   
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