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

ERGOACTIVES DISTRIBUTOR & DROP-SHIP PROGRAM APPLICATION

Name:
Title:
Company Name:
Address Line 1:
Address Line 2:
City:
State/Province:
Zip/Postal Code:	Country:
Phone Number:	Ext:
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 (Amazon.com, Amazon.ca, Amazon.mx, Walgreens.com, CommerceHub.com)

Authorized Signature X______________________

Authorized Name X_______________________

Date ____________________

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Distributor Application

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