RSG Distributor Signup Form

RSG Distributor Signup Form Please fill out the form below as completely and thoroughly as possible. As soon as you are approved you will be contacted with instructions on completing the Distributor signup process.

About You (Primary Contact)
Salutation:	Mr. Mrs. Ms. Dr.
First name*
Last name*
Suffix	Jr. Sr. II IV
Title
Describe your reponsibilities
Email Address*:
Phone*
Fax

Company Information
Company Name*
Division
Subsidiary of
Mailing Address*
City*
State/Province*
Postal code*
Country*
Telephone*
Ext.
Fax
Shipping Address (if different)
City
State/Province
Postal Code


Company Profile
Please provide a general description of the services your company provides.*
Company President
Number of years in business
Number of full-time employees
Current Annual Revenues (in U.S.$)

Sales Distribution Areas:
North America:
South America:
Europe:
Asia/Pacific Rim:
Africa:
Other:

Primary markets (percentages):
Genral Retail:
Crafts:
Screen Printing:
Manufacturing:
Concrete:
Glass:
Art:
Candles:
Tackle/lures:
Plastics:
Signs:
Beauty:
Toys/Novelty:
Jewllery:
Murals:
Other:

Who are your major competitors?
What trade shows do you generally attend?
What trade organizations do you belong to?

Product Information: Which of RSG's products are you interested in distributing?
Product type
What states or territories do you sell in?*
* Are required fields