Dealer Application Form

Company Name*:

Address*:

Country*:

Website:

When was your company set up?

Total number of employees:

E-Mail Address*:

Phone number*:

Contact Name*:

Type(s) of industry you serve*:

What products do you sell?

Do you currently sell beer dispensing equipment?* Yes No

If yes, what brands:

Approximate size of your customer base:

Does your company have sales personnel? Yes No

If yes, how many?

Does your company have capabilities to provide installation, warranty and post-warranty product services?* Yes No

What products is your company interested in:* PEGAS CrafTap (for glass bottles) PEGAS NovoTap (for PET bottles) PEGAS Dragon (beer tower) other

If other, please specify:

What territory shall be allocated to your company as your authorized sales territory? (please, specify, state/province/region, country)*

What shall be the period of distribution rights for your company?*

How many pcs of the Product do you intend to buy during the first 6 month period?

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