Free Distributor Registration Form Template

Distributor Registration Form

Please fill out this form to register as a distributor and begin your partnership with us.

Personal Information

Name

    Business Name

      Address

        Phone number

          Email

            Business Information

            Type of Business

              Years in Business

                Website (if applicable)

                  Tax Identification Number

                    Product Interest

                    Please list the products you are interested in distributing

                      Terms and Conditions

                      1. You confirm that all information is correct.

                      2. You will only distribute [Your Company Name]'s products in the agreed region.

                      3. You will follow our pricing rules and pay on time.

                      4. You handle product delivery after we send it.

                      5. Either party can end this agreement with notice. Return unsold products within 30 days.

                      6. Keep all shared business information private.

                      • I agree to the terms and conditions outlined for becoming a distributor.

                      • I understand the responsibilities and expectations of the distributor relationship.

                      Signature

                      Name:

                      Date:

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                      Thank you for submission!

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