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New Sandmate® Distributor Application Form

Distributor Name:________________________________________________________________Date:___________

Address:_______________________________________________________________________________________

________________________________________________________________________________

City:________________________________________State/Province:______________Zip/Postal Code:__________

Phone #_______________________Fax #___________________Company E-mail___________________________

Company Web Address:___________________________________________________________________________

Principal Contact:_________________________________________Title___________________________________

Principal Contac's E-mail:_________________________________________________________________________

Number of Outside Salesmen:__________________________ Number of Inside Salesmen____________________

Customer Service/Purchasing Contact:_______________________________________________________________

Please list 3 trade references.

1.)____________________________________________________________________________________________

2.)____________________________________________________________________________________________

3.)____________________________________________________________________________________________

Please list Bank information.

Bank Name:___________________________________________________Bank Phone #______________________

Bank Contact Name: _______________________________________________Bank Account # _________________

_______________________________________________________________________________________________

For Sandmate/Karina Fasteners Representative Usa:

Sandmate Representative:_________________________________________________________________________

Target Market:___________________________________________________________________________________

_______________________________________________________________________________________________

Type of Distributor? ________General __________Specific Market ________OEM (original equipment manufacturer)

Do the sell any other Abrasive Material? Specify_______________________________________________________

______________________________________________________________________________________________

What Territory will they sell in? Specify._____________________________________________________________

_______________________________________________________________________________________________

Which Sandmate products lines Specify.______________________________________________________________

Sandmate/Karina Fasteners Ltd.--5525 Cote de Liesse. Montreal. Quebec Canada H4P-1A1

Phone USA (800)-267-9352, Canada (800)-361-9443, (514)-744-9352, Fax:(514)-744-1113