Distributor Application

1. Company Information

Legal Business Name *

DBA / Trade Name

Business Address *

Billing Address *

Phone Number *

Business Email Address *

Website *

Business Type *

State of Incorporation *

Year Established *

Federal Tax ID / EIN *

DUNS Number

Number of Years in Business *

2. Distributor Information

Distribution Business Type *

Number of Distribution Locations *

Number of Customers / Accounts Served

States / Regions Served *

Primary Customer Types *

Do you currently distribute competing brands? *

Yes No

If yes, please list the brands

3. Purchasing Information

Estimated Monthly Purchases from ABRO USA *

Estimated Annual Purchases *

Expected Initial Order Value *

Requested Credit Limit *

Primary ABRO Product Categories *

Purchase Order Required? *

Yes No

4. Accounts Payable / Billing Information

Accounts Payable Contact Name *

AP Email Address *

AP Phone Number *

Preferred Invoice Delivery Method *

Requested Payment Terms *

Net 30

Tax Exempt? *

Yes No

Tax Exemption Certificate

If applicable, please provide your tax exemption certificate.

5. EDI Information

Do you require EDI integration? *

Yes No

EDI Provider / VAN

EDI Contact Name

EDI Contact Email

EDI Contact Phone

EDI Requirements / Additional Information

6. Shipping / Distribution Information

Primary Shipping Address *

Receiving Contact Name

Receiving Phone Number

Number of Warehouses / Distribution Centers

Special Shipping Requirements

7. Business References

Reference #1 — Company Name

Contact Name

Phone

Email

Reference #2 — Company Name

Contact Name

Phone

Email

8. Additional Information

How did you become interested in the ABRO USA Distributor Program?

Additional Comments / Requirements

9. Certification

I certify that the information provided in this application is accurate and complete. I understand that distributor status and pricing are subject to approval by ABRO USA. I understand that submitting this application does not automatically guarantee distributor status or credit approval. I authorize ABRO USA to contact the company and business references provided in this application for verification purposes.

Authorized Applicant Name *

Title / Position *

Date *

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ABRO USA Pre-Qualified Distributor Application

1. Company Information

2. Distributor Information

3. Purchasing Information

4. Accounts Payable / Billing Information

5. EDI Information

6. Shipping / Distribution Information

7. Business References

8. Additional Information

9. Certification