e.Energy Lighting Limited

Application for Distributorship Please fill in the information below. Items with asterisk* must be filled in. Contact
First Name*	Mr./ Ms./ Mrs./ Dr./ Ir.
Last Name*
Position
E-mail*
Company Information
Company Name*
Address*
City*
State/Province
ZIP/Postal Code
Country*
Tel*
Fax
Website
Date of incorporation (dd/mm/yyyy)
Total number of staffs
Brief company descriptions
Business Profile
Market you are serving* - you may tick more than one box Corporate Government Others (please specify )
Mode of cooperation you are interested in* - you may tick more than one box Sole Distributor Standard Distributor Others (please specify )
Please state the territory (province, country) you would like to work with us*
Please state your annual turnover last year
Please state your estimated annual turnover (in US dollars) you can achieve when you become our distributor in your market*
Is your company selling similar products as e.Energy? If yes, please state the brand and model* Yes (please state: No
General Market Information in Lighting Sector
Voltage used by your country *
Electricity tariff rate in your country (US$/kWh)
Please state whether your government have funding for energy saving? Yes (please specify the name of funding and the funding amount ) No
Is there any main competitor in your target territory? If yes, what is their estimated market share?
Is there any product that with a great potential in your market but we are not available yet?
Please let us know if you have other comments or questions.