Distributor Application Form

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

Contact(s)

Contact 1 *

Name *

Email address *

Tel *

Title *

Contact 2

Name *

Email address *

Tel *

Title *

General information

Company Name *

Tel *

Website *

Address line 1*

Address line 2

Zip code *

City *

Country *

State (if any)

Branches or Other locations

Company VAT number (if applicable)

Years in business *

Total employees *

Employees in sales *

Employees in customer service *

Describe any technical background

Commercial information

Description of your marketing activities *

What are your company total sales in us$/euro for the last three years (per year)? *

What Market Segments do you work with? *

Which country(ies) do you deliver to? *

What expertise can you offer to our company? *

Warehouse facilities
yesno

Does your company/country pay import taxes, duties or import fees of any kind? *

If yes, please provide percentage and type of import duty

Sales estimation for Niryo One

Can you estimate your market for the robot ?*

How many units do you think you can sell per year (at least for the next 3 years individually) ?*

When can you start taking orders ? What will be your first order ? ?*

References

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

Company 1:

Contact

Tel

Product or relationship

Company 2:

Contact

Tel

Product or relationship

Company 3:

Contact

Tel

Product or relationship

Additional notes

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