Distributor Inquiry Form

BioPlex DISTRIBUTOR Discount Program requires a modest annual sales requirement with generous product discounts and excellent profitability. Sales & marketing support includes both a digital and printed product guide catalog as well as bio-plex.com and professional corporate tech support.

COMPANY & CONTACT DATA:
Company Name*
Contact Name*
Address*
Street Address Address Line 2 City State Zip Code Country
Email*
Company Office Land-line Phone
Cell Phone*
Years in Business
Current Annual Sales Revenue
Competitive Like Product Brands You Currently Distribute
The MINIMUM Number of Different BioPlex Products You Anticipate to Inventory
Name
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Distributor Inquiry Form

COMPANY & CONTACT DATA: