Distributors Inquiry

Distributor Inquiry

Please kindly fill out the below and send it to us.

Company Name:

Company Location:

Contact Person :

Position with company:

Your Email (required)

Company Type
Independent CompanyBranch OfficeAgentOthers

If Others:

Telephone::

Fax:

Website

Distribution Territory

Please list the territory or territories that your company would like to distribute and represent Kwality :  

Territory A

Territory B


Territory C


Territory D


Please make sure that all information provided above is correct and factual.
Once the form is complete, all information listed will be kept strictly confidential between the company applying and Kwality. It shall not be released to any third party.