Be a Part of Cleaning Chemicals Business | Application For Chemical Distributor

We hereby apply for Distributionship for the products of M/S. RX Marine International, RX Grup of Industries. We declare and confirm that the information provided in the following page(s) are true and correct to the best of our knowledge an believe. We agree to abide by the rules and regulations at the time of acceptance of this application by the Executieve Committee for distribution as imposed upon from time to time by the Board.

Name of Company: *

Address of Head Office: *

Telephone(s)

Office: *

After Office Hours:

Fax:

Answer Back:

E-mail:

Web site:

Name of Key Person: *

Sales Key person contact:

Addresses of Branch Office:

Name(s) of Proprietor(s) / Director(s): *

Form of Organization (Limited etc.):

(Please attach the extract of Registration of Companies)

Categories of Business performed:

Date of Incorporation:

MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day12345678910111213141516171819202122232425262728293031

Year20152016201720182019

Do you supply ships directly?.if yes:

(Please specify the mode)

In what categories of the Ship-stores trade/Shipping related trade do you operate?:

Deck

Slop

Chest

Shipping Agency

Engine

Medicines

Spares/Machinery

Cabin/Pantry/Galley

Provisions

Bonded Stores

Servicing & Engineering

If Specialist:

Warehouse

Size (m 2): *

Type: *

Normal

Bonded

Refrigerated

Office Size (m 2):

Number of trucks/vans:

Total number of employees:

Number of employees in ship supply dept:

(if different)

Name and addresses of foreign representatives:

Name and address of Bankers:

Shipowners regularly served: - None -12345678910

(N.B. Approaches may be made to these companies for reference)

Sole agencies represented:

Names of Manufacturers, Articles and addresses (Please attach separate sheet)

Other references:

(Preferably from Marine line )

How many vessels have your company supplied in the last 12 months?: *

10-50

50-100

100-150

150-200

Above 200

Would you provide us with a photograph of your office, warehouse and facilities owned?:

Yes

No

Are you a certified ship supplier in SINGAPORE:

Yes

No

If so, please provide a copy of Ship Supply license or Port License:

What is your annual volume of business in US$:

50,00000 to 10,000000

10,000000 to 50,000000

Above 50,000000

As a supplier in your own CITY, how would you rate your company?:

In the top 10

10-25

25-50

50-100

Other

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