Hymed Distribution Channel Partner Application
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Thank you for your interest in becoming a Distribution Channel Partner. After you have completed the application form, we will arrange a time to discuss your application. The information gathered on this application will remain confidential.
Company Address (street, state, zip):
Primary Contact Name:
Contact Position Title:
What are your top 3 products in terms of sales revenue? (please include trade names)
Please list the customer, product and industry segments you sell to.
How do you see our products helping you increase market share or enter a new market?
What geographical territory do you sell products into?
Regional (less than 10 states)
National (more than 25 states)
Approximately how many customers do you sell to?
How many products do you represent across your organization?
How many sales agents do you have within your organization?
What are your organization's estimated annual revenue?
Less than $1 million
$1 million to $5 million
$5 million to $20 million
Greater than $20 million
What estimated % of total annual revenue do you think the product you are interested in distributing would capture?
Less than 10%
10% to 50%
50% to 80%
Greater than 80%
How many total employees do you have?
Less than 10
10 - 50
50 - 100
Which sales and marketing efforts do you employ?
Yes - primary
Yes - minimal
No, but considering
No, not considering
Direct sales force
Targeted email marketing
Internet based lead generation
Other media advertising
What products do you think are most competitive against our product(s) and how would you differentiate those products from ours?
Do you represent any competitive product(s) to our product(s)?
If "Yes", what is/are the trade names of those competitive product(s)?
Do you see our product(s) becoming a large part of your portfolio over the next year?
Maybe, not sure
If yes, which product(s)?
What is your most compelling reason for being one of our Channel Partners?
Do you have any market research data you can share with us?