Prospective Distributor Profile Form
 COMPLETE THIS PROFILE FOR YOUR FREE PASSWORD TO ACCESS DETAILED INFORMATION ABOUT ALL SANTE-RX PRODUCTS. We will evaluate your business needs and come back to you with a detailed response. You will receive your special password to access additional information, including pricing, terms and conditions for a distributorship and terms and conditions of sales.

* All fields must be completed in order to process this form.

Company Name:
Address:
City:
State/Province:
Postal Code:
Country:

phone:
Fax:
E-mail Address:
Web site URL:

Your Name and Names and Titles of Key Personnel in the Company:


Banking Information/Capital (include Contact Name,
phone, and Fax:


Years Established:
Annual Turnover:
Total Number of Employees:
Technical Employees:
Sales Employees:
Administrative Employees:

Geogra
phic Area Covered:


Types of Products Distributed:


Products Imported From U.S.:


Competing Products:


Types of Distribution Channels (please be specific):


Warehouse Space (sq meter):
Office Space (sq meter):
Estimated Initial Order:
Estimated First Year Sales:
Projected Frequency of Orders:

Trade Shows Attended:


How Did You Hear About Us?


Enter Any Other Pertinent Information:



Sante-Rx
ph: (970) 535-0128
fx: (970) 535-0129
14469 Mead Court, Unit A
Longmont, Colorado 80504 U.S.A.
Contact us