Become a Distributor

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Phone*

Ownership/Officers:

Do You Want to Provide Company Officers Contact Info?*

Yes!
No, not at this time.

President Name

First Last

Present Phone

President Email

Vice President Name

First Last

Vice President Phone

Vice President Email

CFO Name

First Last

CFO Phone

CFO Email

Important Contacts

Do You Have A Specific Purchasing Contact?*

Yes!
No, not at this time.

Purchasing Name

First Last

Purchasing Phone

Purchasing Email

Accounts Payable Name

First Last

Accounts Payable Phone

Accounts Payable Email

Sale Manager Name

First Last

Sales Manager Phone

Sales Manager Email

Marketing Manager Name

First Last

Marketing Manager Phone

Marketing Email

Purchasing/Sales/Marketing Information

Primary Product Line*

Customer Base*

Distributors
Research Laboratories
Government
Academia/Universities
Commercial Industry
Other

Primary Customers Served*

Geographical Area Served

List Area Competitors:

Check if you currently purchase serum from other suppliers.*

Yes

If yes, what is your annual purchase amount?*

Who are your key suppliers of serum

Peak products of interest*

Anticipated annual purchases of Peak Products:*

Major Means of Promotion

Number of Outside Salesmen:

Number of Inside Telemarketers:

Become a Distributor

IT IS AN EXCITING TIME TO JOIN THE PEAK SERUM DISTRIBUTION TEAM, JOIN TODAY!

Company Information

Ownership/Officers:

Important Contacts

Purchasing/Sales/Marketing Information

Application will be reviewed and a representative will be in contact within 48 hours