Bunting Magnetics » Become A Rep

Distributor/Representative Application

Please fill in information and then click the SUBMIT button below.
* Required Fields - Please include information in these fields.

Application for:

Distributor Representative

Product Group:

Material Handling
Holding Magnets

Separation/Filters
Printing Products

Company:

Name:*

Mailing Address:*

Shipping Address:

Day Phone:*

FAX:

E-Mail:

Website:

Resale Number:

Annual Sales Volume:

President:

Vice President:

Sales Manager:

Primary Inside
Sales Contact:

No. Inside Salespeople: No. Outside Salespeople:

Territory Covered:

Branch Locations:

Major Product
Lines Carried:

Competing Line
& Disposition:

List Major Customers
Who May Use
Bunting® Products:

Branch Locations:

If you are going to be a
stocking distributor,
which products do you
intend to stock?

Do you have a
distributor catalog?

Will Bunting® products
be included?

Do you maintain
a customer mailing list?

Number of names: Can we participate?

What competing
representation to the
Bunting® line is there
in your trading area?

Catalog Amt: Catalog Amt:

Sales samples requested.
How many and what kind?

Other comments.

If distributor application, please list bank and credit references:

Bank Name:

Bank Address:

Bank Phone:

FAX:

Bank Officer:

Credit References

If approved, effective
date of agreement

Completed By:

Date: