ph: 1300 797 747 or +617 5564 6000


Distributors application form

General Information
Company Name Contact Name
Email* Phone
Fax    
Address Suburb
State Post Code
Enquiry
 
General company's information
No. of employees
Years of company establishment
Anticipated volume next year
 
Marketing information
Possible / proposed distribution region:
 
What percent of your company's sales are to the following channels?
Electrical contractors:
Wholesalers:
Retailers:
Original Equipment Manufacturing Companies:
End user customers (government, hotels):
Other:
Any other information you wish to provide:
 
* Required Fields

Contact Regis iem

Postal Address: PO Box 5646 GCMC, Qld 9726
Address: 21 Activity Cres, Ernest Qld 4214
E-mail: enquiries@regisiem.com

PH: 1300 797 747 or 07 5564 6000
FAX: 1300 797 737 or 07 5564 6638