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.
Company Name: *
Your answer
Primary Contact Name: *
Your answer
Email Address: *
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Phone Number: *
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Company Address: *
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Website:
Your answer
Number of Years in Business: *
Your answer
Number of Staff: *
Your answer
Territories: *
List the Countries and Territories you currently distribute to:
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Annual Revenue: *
Specify currency:
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Product Range: *
Please list the Brands and Products you currently distribute:
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Reseller Accounts: *
Please provide number of current accounts along with the account names and standings, ex: Retail Location, Pharmacy, Small Resellers, etc:
Your answer
Distribution Model: *
What channels and methods you plan to use to distribute our products? List any websites if you plan to sell online:
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Future with Relumins *
Tell us your future business plan with our Relumins products:
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