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Distributor Application

*Please respond the following questions in the message contact form or email this application to with subject line: Distributor App*








Company Name:


Address Line 1:


Address Line 2:






Zip/Postal Code:


Phone Number:


Email Address:







Provide a brief description of your company, how many years in the distribution business, and the types of products you currently distribute.







Provide a listing of markets, geographical areas and types of customers you surrently sell to.







How does your company go to market (internet, personal selling face-to-face, phone sales, retail outlet, etc)?







Which Ergoactives product(s) do you want to buy and re-sell?





Who are your targeted customers?


 I agree to follow Ergoactives instructions in regards to product descriptions, product images, and product placement/targeting.

□ I agree to sell Ergoactives products at the MSRP suggested by Ergoactives
□ I agree not to sell Ergoactives product line outside the website owned by our company.

□ I agree not to sell Ergoactives product line on the exclusive contracted websites by Ergoactives (,,,,


Authorized Signature X______________________                  

Authorized Name X_______________________

 Date ____________________


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    TOLL FREE: 1-800-231-6393

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