First Name *

Last Name *

Email *

Phone Number *

Company name *

Contact person's name *

Your company's primary business *

Products which your company currently distribute? *

Do you have Authorized/ Sole Distributorship Rights of any brand/s. if yes, name them *

How many retail sales outlets does your company have access to *

Do you have your own product distribution vehicle. If yes, how many

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Do you have warehouse and storage facilities. If yes, how many and their respective sizes (sq. m) *

Any other information you would like to provide

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