REQUESTED TERRITORY
Please specify the territory you are applying for and include the principal region and city within that territory. The reason for this is that the country may be assigned to another distributor, but you may qualify as a sub-distributor for a particular area

COUNTRY

REGION

MAJOR CITY

PRESENT CHANNELS OF DISTRIBUTION
Whom do you presently sell to, or are qualified to sell to?

MARKET SERVED
How many dermatologists and skin care professionals are there in your market and how many of them do you sell to?

PRODUCTS PRESENTLY DISTRIBUTED
What products do you presently distribute? Are there any possible conflicts?

SIZE OF BUSINESS
Can you tell us about the size of your business - how many people do you employ, what are your approximate annual sales (in $US)?

COMPETITORS
Who are your largest competitors, how do you rank in size, and what are your competitive differences?

WAREHOUSING
Do you have your own warehousing, packing and shipping facilities? Please describe. Cellex-C products must be kept in a clean, secure, temperature-controlled area.

CUSTOMS
Are you familiar with all the customs and tax regulations pertaining to the territory? Remember, we sell F.O.B. Toronto. Also, who is your customs broker?



SPECIAL IMPORT REQUIREMENTS
Are there any special government registrations required of Cellex-C products before you can import them into your country? Are you able to comply with these requirements?



YOUR SALES FORCE
Please tell us a little about your representatives and their qualifications to sell a product like Cellex-C. Which territories do each presently handle?

MORE ABOUT YOU
It would also be helpful to know about your own qualifications and why you feel they are appropriate for representing Cellex-C.



MORE ABOUT YOUR COMPANY
Do you have other shareholders or partners? Could you please tell us a little about them and the role they play in your business.



MARKETING & PROMOTION
Do you have your own resources for translating and adapting basic marketing materials for your own markets? It is our expectation that distributors produce marketing materials in the language(s) of their country/territory.



CAPITALIZATION
Could you please indicate the amount or range of capitalization that you could make available for this business opportunity. Our concern is that you will be able to finance rapid inventory growth during the first three years.

CREDIT REFERENCES
Please provide us with the following credit information:

BANK (ADDRESS, CONTACT, PHONE NO.)

(1) MAJOR SUPPLIER (COMPANY, ADDRESS, CONTACT, PHONE NO.)


(2) MAJOR SUPPLIER (COMPANY, ADDRESS, CONTACT, PHONE NO.)


FORECAST
Forecasting is always difficult, but we require some indication of the size of market you intend to pursue. Please indicate your target dollar volume of orders - from Cellex-C. Please state a range from low to high in $US.

YEAR ONE
LOW: HIGH:

YEAR TWO
LOW: HIGH:

YEAR THREE
LOW: HIGH:

BUSINESS APPROACH
Please outline your basic business approach and timetable for achieving this forecast.





INFORMATION ON CELLEX-C
As an applicant, we are limited to the amount of information we can provide you at this time. More in-depth and technical information will be provided to qualified distributors upon request.

TIMING
Please allow several weeks for Cellex-C International Inc. to review your company's application.

CONFIDENTIALITY
We respect that you are submitting this application in confidence. Therefore, Cellex-C International Inc. agrees not to disclose any of the contents to any other company or individual outside of our company without your expressed approval.

THANK YOU
We sincerely appreciate the time and interest you have taken in completing this application and look forward to speaking with you.