Join Wells Johnson Company Today

Thanks for your interest, and we welcome the opportunity.

Authorized Distributor Application

The below Application Form is designed to provide us with valuable information about your company, of which we are hopeful and poised for a business relationship.

*Please note that Wells Johnson is currently not accepting applications for U.S. distributors.

Distributor Application Form

Requested Territory

Country*

Region*

Major City*

Present Channels of Distribution

Whom do you presently sell to or are qualified to sell to?*

Plastic Surgery

Cosmetic Surgery

Other: Please specify

Other Channels of Distribution*

Products Presently Distributed

What products do you presently distribute? Please include U.S. companies, if any.*

Number of Employees*

Annual Sales Volume*

Number of Sales Representatives*

Competitors

Who are your largest competitors, how do you rank in size, and what are competitive differences?*

Customs

Are you familiar with all the customs and tax regulations pertaining to the territory?*

Yes

Are there any special government registrations required for Wells Johnson products before you can import them into your country? Are you able to comply with these requirements?*

Marketing and Promotion

Do you have your own resources for translating and adapting basic marketing materials, such as literature, for your own markets? It is our expectation that distributors produce marketing materials in the language(s) of their own country/territory.*

Yes

References

Company 1

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact

Phone

Company 2

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact

Phone

Comments

This field is for validation purposes and should be left unchanged.

Join Wells Johnson Company Today

Authorized Distributor Application

Distributor Application Form

Company Information

Requested Territory

Present Channels of Distribution

Products Presently Distributed

Competitors

Customs

Marketing and Promotion

References

Pages

Products

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