Potential Industrial Applicator Assessment Document (PIAAD)

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Potential Distributor

Company Name Of Potential Distributor: *

Company Annual Sales Turnover in Euro:

Current Types of surface Preparation Equipments:

Market Coverage in Geographical term:

Branches of Company:

Total Number of Employees in Company:

Total Number of Sales Employees in Company:

Current Market Target:

Address Of Potential Distributor

Representative Name *
Position Of Representative *
Year of service of Representative in the company
Street
Postal Code
City
State
Country of Residence *
By submitting this form you affirmatively acknowledge and agree that this non-U.S. Henkel website is not intended to and does not purport to have as a purpose the sale of any products, services and / or securities to U.S. persons or entities. Further, you agree that you will not use the non-U.S. Henkel website or its information as basis for asserting jurisdiction over Henkel AG & Co. KGaA, any other non-U.S. entity of Henkel, and/or any of Henkel's non-U.S. employees, Directors, Officers or agents in a U.S. court of law. (go directly to Henkel North America web site now.)
Phone
Fax
Email *
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