Become a Distributor

Distributor Application Form

Thank you for your interest in becoming a distributor for FarmersOrigin. Please fill in the form below.

Personal and Business Information Full Name: Company Name: Address: Phone Number: Email Address: Website:

Business Profile Type of Business: Years in Business: Describe your current product range and industries served: Geographic area covered: Number of employees: Experience with hydroponic or nursery products:

Logistical Capabilities Do you have warehousing facilities? Yes No Warehouse space area (if applicable): Describe your distribution capabilities:

Financial Information Annual Revenue (USD): Willing to commit to a minimum purchase volume? Yes No Expected purchase volume (USD):

Additional Information Why are you interested in becoming a distributor for FarmersOrigin? How do you plan to promote and sell FarmersOrigin products?