Dealer application form

DEALER APPLICATION
(We are extremely busy so please inquire only if you are very serious!)

We will be accepting a limited number of applications for Dealers!

We are looking for Dealers through out the USA, Canada, also Dealers from around the world are encouraged to apply!

If you feel you would be a good distributor of high quality Perma Pak® low moisture
dehydrated food, please fill out the information below. We will contact you after we have had chance to review the completed form and find the information appropriate.

Please fill in the following personal information:

FIELDS MARKED WITH A * ARE REQUIRED!

                                Date:

      Your Company Name:

                    First Name: *

                    Last Name: *

                        Address: *

                               City: *

                             State: *     Zip: *

                           Country:

                 Home Phone: *     Work Phone:

                                 Fax:

                    Your Email: *

Please provide two business references: *

Business: *

Contact: *

Phone : *

Business: *

Contact: *

Phone : *

Please provide two personal references: *

Name: *

Phone : *

Name: *

Phone : *

Please answer the following questions in as much detail as possible:

Please tell us about your food storage experience! *

Please tell us about your sales and business experience! *

Please tell us the reason you want to be a dealer? *

How and where do you plan to market these products? *

Additional Comments:

We thank you for taking the time to fill out this information. If you have completed the form , please click on the "Send Form" button below.

If you have any problems with this form, email us: Here!

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Emergency Food Storage Solutions is an authorized Perma Pak® distributor.
Perma Pak® is a registered trademark of Vacu-dry Company