AgriEyes Distributor Application Form


Personal Information:

1. Full Name:

2. Company Name (if applicable):

3. Contact Number:

4. Email Address:

5. Street Address:

6. City:

7. State/Province:

8. Zip/Postal Code:

9. Country:


Business Information:

10. Years of Experience in Distribution:

11. Nature of Business (e.g., retail, wholesale, online):

12. Website (if applicable):

13. Briefly describe your current product line(s) and target market:


Distribution Details:

14. Are you currently distributing similar products? If yes, please provide details:

15. How do you plan to promote and distribute AgriEyes products in your market?

16. What differentiates your distribution business from competitors?

17. Have you ever been a distributor for another brand? If yes, please provide details:

18. Are you able to meet the minimum order requirements for AgriEyes products?

19. Are you interested in exclusive distribution rights for a specific territory? Please specify:


Additional Information:

20. Why are you interested in becoming a distributor for AgriEyes?

21. How did you hear about AgriEyes?


Please attach any additional documents or information that you believe would support your distributor application.



By submitting this application, I confirm that the information provided is accurate and complete to the best of my knowledge. I understand that AgriEyes reserves the right to accept or reject distributor applications at its discretion.


Signature: ___________________________________________


Date: _______________________________________________


Please email the completed application form to or submit it online through our distributor portal.


Thank you for your interest in becoming an AgriEyes distributor. We will review your application and get back to you shortly.



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