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Distributor Application Form

Which products are you interested in?
K-Series Kitchen/Galley fire suppression system Stat-X Condensed Aerosol system Both 

First Name (required)

Last Name (required)

Title (required)

Company (required)

Address

Telephone Number (required)

Email (required)

Website

Number of Employees

Industries you work in

Do you have employees that are certified to design and/or install fire suppression systems including certifications held from the recognised governing agency or entity?
Yes No 

Insurance do you carry the following insurance coverage?

£10,000,000 Employers Liability
Yes No 

£2,000,000 Public and Products Liability (inclusive of efficacy cover)
Yes No 

Products you currently offer

Regions in which you market

How do you plan to market the product line if a distributor?

 Estimated sales in Year 1 (no. of units)

 Estimated sales in Year 2 (no. of units)

Comments or Questions: