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Company Name*

Parent Company (if any)

Owner/CEO*

Primary Contact*

Corporate Address*

City/State/Zip*

Is there an alternate address?*

No
Yes

Alternate Address*

City/State/Zip*

Telephone Number*

Email Address*

Company Website*

Type Of Business*

Years in Business

Annual Gross Sales

Number of Employees

What Serola products are you interesting in selling?*

Number of salespersons?

Estimated number of customers?

What percentage of retail/end user customers do you sell to?*

What percentage of health professional customers do you sell to?*

What territories are served?*

How are orders captured, processed and shipped by your company?*

What percentage of your sales are on line sales via your company website?*

What percentage of your sales are brick & mortar sales?*

Do you sell on Amazon?*

Yes
No

What percentage of your on line sales are from third party e-commerce sites, i.e. Amazon, eBay, etc.?*

Provide links/URLs for any on line sales portal*

Please describe your experience selling via third party e-commerce sites, i.e. Amazon, eBay, etc.*

Serola maintains the exclusive right to sell its products on Amazon. No sales from a 3rd party selling Serola products on Amazon are authorized. If any customer is found to be selling Serola Products on Amazon without the express written consent of Serola, their agreement will be immediately terminated and they may be subject to be place on our Unauthorized Seller List. The undercutting and poor business practices that Amazon enables have forced Serola into taking strict measures to protect our loyal and dedicated customer base.

What are the main healthcare sectors your company serves?*

Provide at least 3 main brands/product lines sold*

Provide at least 3 of your company’s main competitors*

What is the standard procedure for launching new products and plan for building the Serola brand?

Provide any industry specific publications and/or marketing channels used for advertising

Does your company attend any industry specific trade shows?

Yes
No

Name of Trade Shows

Name of Individual Completing Web Form*

By typing your name into this box, you certify that all information is true and accurate to the best of your knowledge.

Title*

Direct Telephone Number*

Email*

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