Händler-Bewerbungsformular

Full Name*

PrefixFirst NameLast Name

Company*

E-mail*

Phone Number*

Area CodePhone Number

Website*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

What is your current business?*

Customer Type*

How long have you been in business?*

Size of business (staff)*

Current turnover*

Please list any relevant professional accreditations*

How many years experience in the heating industry?*

Approximate size of your heating market (Number of customers or approximate value)*

Do you already have experience of far infrared?*

YesNo

Are you already selling another Infrared manufacturers products? *

YesNo

If yes, whose?*

What is your estimate of sales (numbers of heaters) for your first year of operation?*

If you become a Herschel Dealer you agree:

I will take the Herschel Accreditation Training*

YesNo

I will protect copyright and intellectual property in my membership of the Herschel Technology Centre*

YesNo

Message

Many thanks for your answers

Lead Source

Assigned-to

Lead Type

Please enter the code exactly as shown*