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Distributor/Representative Inquiry

Are you interested in becoming a Representative or Distributor for VorTek Instruments? Please feel free to contact us.

General Information


NOTE: Fields in RED below are REQUIRED.
Rep or Dealer Name
Owner
Address 1
Address 2
City, State, ZIP	, ,
Country
Phone
Fax
Email
Website
Date Established	/ (MM/YYYY)
Territory/Area Served

Industries Served


Select Industries You Serve	Enter Annual Sales in 2008 (USD):
Food and Beverage	$
Pharamaceutical	$
Chemical	$
Water/Wastewater	$
Pulp and Paper	$
HVAC	$
General Industrial	$
Mining	$
Other	$

Principles


Company
Year Line Acquired
Products
Annual Sales

Sales Personnel


#1	Name
	Territory
	Job Title
	Date Hired

#2	Name
	Territory
	Job Title
	Date Hired

#3	Name
	Territory
	Job Title
	Date Hired

#4	Name
	Territory
	Job Title
	Date Hired

#5	Name
	Territory
	Job Title
	Date Hired