Dealer aanvraagformulier

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 above, 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 in advance for your responses.

Lead Source

Assigned-to

Lead Type

Please enter the code exactly as shown*