Distributor Application

Name:

Title:

Company Name:

Address Line 1:

Address Line 2:

City:

State/Province:

Zip/Postal Code:

            Country:

Phone Number:

            Ext:

Email Address:

Provide a brief description of your company, how many years in the distribution business, and the types of products you currently distribute.

Provide a listing of markets, geographical areas and types of customers you surrently sell to.

How does your company go to market (internet, personal selling face-to-face, phone sales, retail outlet, etc)?

Which Ergoactives product(s) do you want to buy and re-sell?

Who are your targeted customers?

 I agree to follow Ergoactives instructions in regards to product descriptions, product images, and product placement/targeting.

□ I agree to sell Ergoactives products at the MSRP suggested by Ergoactives
□ I agree not to sell Ergoactives product line outside the website owned by our company.

□ I agree not to sell Ergoactives product line on the exclusive contracted websites by Ergoactives (Amazon.com, Amazon.ca, Amazon.mx, Walgreens.com, CommerceHub.com)