Distributor Application Form

Domestic Distributor Terms

• Payment Terms are net 30
• First time order must equal a minimum of $500.00, after that there are no minimums
• FOB: Scottsdale, AZ Sper Scientific Ltd.

Sper Scientific Ltd. Distributor/Rep Application Form can be submitted online if you have a default mail client (Outlook, Yahoo, Gmail, etc.) setup. If not, please download and complete this fillable PDF, and send as attachment to sales@sperscientific.com.

Your Information:



  Company Name:
  

  Phone #:
  

  Fax #:
  

  Email:
  

  Address:
  

  President/General Manager:
  

  Contact:
  

Trade References:


  Reference 1 Name:
  

  Phone #:
  

  Fax #:
  

  Address:
  

  Reference 2 Name:
  

  Phone #:
  

  Fax #:
  

  Address:
  

  Reference 3 Name:
  

  Phone #:
  

  Fax #:
  

  Address:
  

Sales Information:



  Annual Sales ($):
  

  Number of Sales People:
  Inside Sales:
  

  Outside Sales:
  

  Do you produce and distribute a catalog?
   Yes (please send us a copy)
   No

  Where do you distribute your products? (geographically)
  City: Country:
  City: Country:
  City: Country:

  What markets do you cover?
   Laboratory
   Education
   School
   Safety
  Other:

  What products do you import now?
  Country: Manufacturer:
  Country: Manufacturer:
  Country: Manufacturer:

  What products do you plan to import?
  Country: Manufacturer:
  Country: Manufacturer:
  Country: Manufacturer:

Bank Information:



  Bank Name:
  

  Phone #:
  

  Fax #:
  

  Address:
  

  Account #:
  

  Federal Tax #:
  

  Resale #:
  

Shipping Information:



  Shipping Methods: (Select all that apply)
   FedEx
   UPS
  Other:

  Insurance Requirements:
  
 

Please ensure all forms are completed before clicking submit: