Xumco International

Surgical Instruments
Dental Instruments
Beautycare Instruments
Veterinary Instruments

Distribution Request

How can we start business with you?
If you wish to be the exclusive distributor of our product in the whole or only a specified part of your country,
you will have to provide us with following information that your company.

Dealer Name:

Name of Parent Company of Subsidiary:

Billing Address:

Shipping Address:

Phone#:

Fax#:

Email:

Website :

Business is A:

Propritership Partnership Corporation

Year Established:

Type of Business:

Annual Sales US$:

No of Employees:

Principal Owners

Name	Title	Address	Phone#

Person to Contact:

Title:

Address:

Name of Applicant:

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