Distributor Application Form
Products
Pacifier Plus® Fever Indicating Pacifiers
Green Ball Baby Temp® Fever Indicator
Green Ball 3-level Temperature Indicator
Green Ball Pacifier Thermometer

Thermometers
Green Ball Forehead Fever
Green Ball Digital Fever
Green Ball Baby Fever
Green Ball Baby Bottle
Green Ball Baby Bath
Green Ball Baby Nursery
Green Ball Room
Green Ball Refrigerator

Comfort™ Line
Green Ball Baby Feeding Accessories

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Babytech International LogospacerInternational Customer
Profile Form
Please print or type all information. This form must be fully completed. Attach additional sheets if needed. When completed, please send by fax to (xxx) xxx-xxxx, or send requested information to us via e-mail at babytech@pacbell.net. You may also download (38k) this Microsoft Word 7.0 document directly.

1. COMPANY INFORMATION:
1.1 Full Company Name: ______________________________________________________________
Contact Person: ____________________________ Title: __________________________
Street Address: ______________________________________________________________
Mailing Address: ______________________________________________________________
City: ____________________________ Country: __________________________
Telephone No. ____________________________ Fax No. __________________________
E-mail/Internet Address: ______________________________________________________________
1.2 Form of Business (Corporation, Partnership, Sole Proprietorship, with date/year company founded):
__________________________________________________________________________
2. BUSINESS OPERATIONS:
2.1 Your type of business:
? Trading Company ? Importer/Indenturer ? Contractor Packaging Co.
? Wholesaler/Distributor ? Commission Agent ? Retailer
? Import/Export Broker ? Manufacturer
2.2
No. of Employees:_______No of sales persons: _____Size of warehouse: _____
2.3Your type of customers - list how many and in order of importance:
How many?How many?How many?
___ Wholesalers:______ Chain Stores:______ Hospitals/Health Clinics:___
___ Distributors:______ Department Stores:______ Doctors' Offices:___
___ Importers:______ Independent Retailers:______ End-Users:___
Others, please specify_______________________
2.4List the area/territories in which your company is active:____________________________________
2.5List all products or brands handled by your company:___________________________________________________________________________
___________________________________________________________________________________

3.MARKETING/SALES:
3.1Specify your estimated sales projections for our products:
1st Year:US$_________Units:_________
2nd Year:US$_________Units:_________
3rd Year:US$_________Units:_________
3.2Do you advertise the products you represent? Yes____ No____
3.3Will you actively advertise and promote our product line? Yes____ No____
If yes, please specify the media you recommend and the estimated annual cost:___________________________________
___________________________________________________________________________
3.4What trade fairs/shows do you recommend for participation? Specify the locations, dates, approx. visitors attendance, and approx. space/booth costs:
__________________________________________________________________________

4.REFERENCES:
4.1Trade references:
List your 3 largest product line representations, preferably U.S. Companies:
Company Name/AddressContact PersonTelephone and Fax
Numbers
1.







2.







3.







4.2Bank references:
Bank Name/AddressContact PersonTelephone and Fax
Numbers
1.







2.







5.OPTIONAL - MARKET INFORMATION:
5.1Statistical information:
Countries or RegionsTotal PopulationBirth Rate per 1,000Total Number of
Infants in Age Group
0-24 months












5.2Competitive products information: Please list imported and locally made FEVER thermometers in these categories: fever indicating pacifiers, digital thermometers, and glass thermometers.
Brand NamesProduct NameCountry of Origin
or Manufacture
Average Consumer
Selling Price in US$
















6.SPECIAL INFORMATION:
Add, and/or attach, any other information you feel is appropriate which may assist BABY TECH INTERNATIONAL, INC. in evaluating your company and to better understand any special market/marketing conditions as may be applicable to our tpe of products in your market(s).
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Form Completed By:

Name: _____________________________ Title: _______________________ Date: ______________

Return by fax to: (xxx) xxx-xxxx:
BABY TECH INTERNATIONAL, INC.

If you've found us from another site, please go to our Home Page for information on our other products. Distributor inquiries go to our Customer Profile Form.

Copyright ©1996 - 2003 Baby Tech International, Inc.
Telephone: xxx-xxx-xxxx, Fax: xxx-xxx-xxxx E-mail: babytech@pacbell.net. Last updated September 26, 2004.