UNITED STATES
Tel: (813) 994-3356
Fax: (813) 994-1237
E-Mail: Paragon - USA

ASIA
Tel: 65-6841-2818
Fax: 65-6841-5988
E-Mail: Paragon - Asia+

Agent / Distributor Questionnaire

Simply fill in the form and submit your request or you may download this form in a Microsoft Word format by clicking HERE, then fax it to us. (USA fax number: (813) 994-1237; Asia fax number: 65-6841-5988.)

Company Information

Company Name:
Company Address:
City, State & Zip:
Country:
Company Phone:
Company Fax:
E-Mail:

Officers:

President:
Vice Pres.:
General Mgr.:
Sales Mgr.:
Finance Mgr.:
Service Mgr.:

Products You Sell Exclusively

1.):		% of Sales:
2.):		% of Sales:
3.):		% of Sales:

Products You Sell Non-Exclusively:

1.):		% of Sales:
2.):		% of Sales:
3.):		% of Sales:

Sales Promotion

Are you willing to share sales promotion expenses?

Check here to indicate yes

 

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