Agent-Dealer-Distributor - American Tripoli and Sandstone

Thank you for your interest in representing American Tripoli. If you are interested in reselling or distributing American Tripoli products, please complete the form below. Your application will be reviewed by one of our sales team members within two business days. Please fill in this form with as much detail as possible. All information will be kept confidential.

Full Name:*

Email:*

Position or Title:*

Phone:*

Website:*

Company Name:*

Trading Name:

Year Business Founded:*

Number of Locations?:

Number of employees:

Address (1)*:

Address (2):

City*:

State/Province*:

Postal Code*:

Country*:

Are you applying to be a dealer or a distributor? (Please select all that apply)*

Dealer-Not StockingDealer-StockingDistributor - StockingSales Agentother's describe below

What is your business type? (Please select all that apply)*
Retail StoreDealerWholesale DistributorOther (please specify below)

What types of products do you currently sell?*:

What area/region/territory do you sell to the most?*:

List the top three products which are currently sold by your company:

Which of our products are you interested in selling?*:

How do you plan to market and display our products?*:

Anticipated initial order size? ($USD)*

Customer and Vendor Trade References (if you prefer, please attach them as a separate document below)

Optional Attachment - Trade References (PDF or DOC format only please)

Additional Comments