Please select which product you would like to distribute:
Health Product: Magnesol
Health Product: Baba de Caracol
Health Product: Maca Forte
Clothing: Peruvian Clothing
Jewelry: Peruvian Jewelry

Name:

Company:


Email:

Phone:

Address:

Address (Con't) :

City:

State:

Country:

Zipcode:

Questions:

1) How did you hear about our product?


2) How will you sell the product?


3) What geographic regions do you cover?


4) How long has your company been established?


5) Do you have a physical store?


6) What other products do you distribute/sell?


7) Approximately what volume (in US $) do you expect to purchase from Peruvian Channel for your territory?


8) Approximately how many clients do you have who might be interested in the product?

9) What would be your plans to advertise, exhibit, and/or promote our product?

10) What else can you tell us about your operation and experience? Please provide us with brochures, websites or any additional printed materials that you may have.



Other comments, questions, or details you care to include: