Relumins Reseller Application
Please let us know more about your company and what areas of distribution you have by filling out the Reseller Application below.
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Company Name: *
Primary Contact Name: *
Email Address: *
Phone Number: *
Company Address: *
Website:
Number of Years in Business: *
Number of Staff: *
Territories: *
List the Countries and Territories you currently distribute to:
Annual Revenue: *
Specify currency:
Product Range: *
Please list the Brands and Products you currently distribute:
Reseller Accounts: *
Please provide number of current accounts along with the account names and standings, ex: Retail Location, Pharmacy, Small Resellers, etc:
Distribution Model: *
What channels and methods you plan to use to distribute our products? List any websites if you plan to sell online:
Future with Relumins *
Tell us your future business plan with our Relumins products:
Select Brands You Intend To Distribute
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