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. Distributor/Rep Application Form

Form can be submitted online if your default mail client is Outlook.

If not, please download form, fill-out, and send as attachment to sales@sperscientific.com

Company name:
Phone #:
Fax #:

Email:

Address:
President/General Manager:
Contact:
Annual Sales ($):
Number of sales people:
inside sales:
outside sales:
Do you produce and distribute a catalog?
If yes, please send us a copy
Yes
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:
Three Trade References:
1) Name & Address:

Phone:
Fax:    

2) Name & Address:

Phone:
Fax:    

3) Name & Address:

Phone:
Fax:    
Bank Address & Phone/Fax #:
Account #
Federal Tax #
Resale #
Shipping Methods
(Fed Ex, UPS, Etc.):
Insurance Requirements:

Thank You