Distributor application

Please fill out this form to become a Niryo distributor. We'll come back to you soon.

    Contact

    Name *
    Email address *
    Tel *
    Title *


    General information

    Company Name *

    Tel *
    Website *
    Address line 1*
    Address line 2
    Zip code *
    City *
    Country *
    State (if any)
    Years in business *
    Total employees *
    Employees in sales *
    Employees in customer service


    Commercial information

    Do you already distribute robotics products?*
    YesNo

    If yes, which ones?

    What are your total sales for robotics products last year?


    What is/are your main target customer/s in Education?*
    Comment:
    Do you sell to vocational training?*
    YesNo
    Comment:
    Do you sell to companies for R&D?*
    YesNo
    Comment:
    Do you go to tradeshows?*
    YesNo
    Which ones?
    Which ones?

    How do you plan to market Niryo’s product on your territory?*

    What territory can you actively cover?*

    Any warehouse facilities ?
    YesNo


    Sales estimation for our products


    References

    List 3 companies you represent whom we may contact for a reference

    Company 1:

    Contact
    Tel
    Email

    Company 2:

    Contact
    Tel
    Email

    Company 3:

    Contact
    Tel
    Email


    Additional information

    If you have a question or some additional notes, please write them here