<p> Sales Channel Registration</p><p>Date: Company Information</p><p>Company Name: </p><p>Billing Address: </p><p>Shipping Address: </p><p>Phone: Fax: Email: Web Page: </p><p>Sales Distributor Jobber/Contractor OEM Representative</p><p>Financial References Company Name Contact Name Phone Number Email Address</p><p>Territory Description</p><p>Shipping Restrictions or Requirements:</p><p>Sales Channel Registration</p><p>Management Staff: (Include Email and Cell Phone) Name Cell Phone Email Address Managing Director Financial Director Technical Director Chairman </p><p>Outside Sales Staff: (Include Email and Cell Phone)</p><p>Name Cell Phone Email Address</p><p>Inside Sales Staff: (Include Email and Cell Phone)</p><p>Name Cell Phone Email Address</p><p>Bank Details for Transfers by Detcon into Company Account (Detcon pays money into Distributors account in the form of destination commission. This is accomplished by wire transfer (if applicable) into your account therefore swift account and bank details are required.)</p><p>Bank Name Account Number Registered Name of Account Holder </p><p>Address Swift Code Bank Address </p><p>Other – IBAN Code </p><p>Submitted by: Date: </p><p>Region: </p><p>When complete save and print then send via EMAIL to: [email protected] or via FAX at 281-292-2860</p><p>R071409</p><p>Page 2 of 2</p>