DISTRIBUTOR APPLICATION General Information

Company Name

Contact Person

Address (No PO Box)

City State/ Province

Postal Code Country

Email Website

Phone Fax

Company Information

Year of Establishment

Number of Employees Number of Sales Persons Number of Engineers

Main Products/ Services

Main Customers Petroleum Industry Chemical

Oil & Gas Industry Water Industry

Power generation Mining

Other

Annual Turnover Percentage of Valve Business

Inventory Value (if applicable)

Percentage of Valve Stock

Require Documents to Submit:A. Proof of Company Registration B. Company Picture C. Warehouse Picture (if applicable)D. 3 Copies of Sales Invoice for valves from within the previous six (6) months.

Indicate the sales region or client base or specify major client you would like to represent Australian Pipeline Valve for below:

Please complete this form, sign and send by email to: admin@globalsupplyline.com.au

Name: Date:

Title: Signature:

APV Distributor Application R1 - AS