Distribution Request Form

First of all we would like to thank you for your interest in our Jessica B™. Eiger Timepieces™ and Pupuce™ products.

The Polminton Authorized Distribution Program is geared to identifying, reaching, qualifying, authorizing and supporting external companies capable of distributing our products in their respective local markets

Please take a minute to fill in  the form below and we will contact you shortly with detailed distributorship information.

   Please fill out the following form:

 

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail
URL

    What other products do you presently distribute?

   In What other business interests are you presently involved?

   Do you operate as a sole entity or are part of another business operation?

   What is your marketing experience and business background?

   In which product are you interested in?

  How much time you plan to dedicate to this project?