SWEPCO Distributor Application Form

PLEASE COMPLETE THIS APPLICATION ONLY IF YOU DO NOT LIVE IN THE UNITED STATES, CANADA OR EUROPE

Thank you for your interest in a Distributor opportunity with Southwestern Petroleum. Please tell us about yourself!

Here is your chance to tell us about your valuable experience … whether it is in sales … or knowledge of equipment or maintenance … or other knowledge of the markets we serve.

These questions are designed to help us during the interview and selection process. There are no right or wrong answers. Nor do any individual questions determine your suitability for this position.

So please complete the information form below and attach your resume if you have one. It will take only five minutes or less. When you are done click on the "SUBMIT" button. All the information you provide will be held in the strictest confidence. Thank you again for your interest. We will be in contact with you shortly to discuss the first phase of our interview process.

Where did you hear about SWEPCO Lubricants opportunity? (Select only one please) *

YOUR CONTACT INFORMATION:

First Name: *

Last Name: *

Email Address: *

Mailing Address 1: *

Mailing Address 2:

City: *

Country: *

Zip or Postal Code: *

Do You Have a Valid Travel Visa to the United States?

Do You Have a Valid Passport?

Mobile Number: *

Phone Number: *

Skype ID

Best Time to Reach You

FINANCIAL INFORMATION (please list figures in US dollars)

Income From Current Occupation: US$

Income From Other Sources: US$

Please Explain Other Income:

Estimate Your Individual Total Net Worth (Assets - Liabilities): US$

YOUR COMPANY INFORMATION:

Name of Your Company:

Company Address:

Company City:

Company Country:

Company Postal Code:

Company Website:

Type of Organization:

Year Founded:

Name of Principal Officer or Owner:

SALES EXPERIENCE:

Current Territory (Country/Coverage Area/Region):

Please specify the territory you are applying for and include the principal region within that territory. Be specific about your information.

Please List Your Current Channels of Distribution Below:

Product 1:

Industry You Sell This Product To:

Supplier:

Product 2:

Industry You Sell This Product To:

Supplier:

Product 3:

Industry You Sell This Product To:

Supplier:

Please Provide Annual Sales Volume in US$ for Past 5 Years:

Year:

Turnover: US$

Year:

Turnover: US$

Year:

Turnover: US$

Year:

Turnover: US$

Year

Turnover: US$

Please Indicate the Amount of Capital You Could Make Available for This Business Opportunity:

Who Are Your Largest Competitors? How Would You Rank Yourself in Size and What Makes Your Organization Unique?

Are You Familiar With the Customs and Tax Regulations Pertaining to Importing to your Country?

YES

Trade References:

Name of Reference:

City / Country

Name of Reference:

City / Country

Name of Reference:

City / Country

Please Attach Your Company (Financial) Information:

Please attach your resume or CV if available:

ENTER THE SECURITY CODE YOU SEE IN THE IMAGE BELOW AND THEN PRESS THE SUBMIT BUTTON. THE ENTRY IS NOT CASE SENSITIVE. IF YOU MAKE A MISTAKE SIMPLY ENTER A NEW CODE THAT WILL APPEAR IN THE IMAGE.

NOTE: IF YOU DO NOT RECEIVE A RESPONSE WITHIN TWO BUSINESS DAYS, PLEASE CHECK YOUR SPAM FOLDER FOR A RESPONSE IN CASE YOUR EMAIL SYSTEM INDENTIFIED OUR EMAIL AS SPAM.

Southwestern Petroleum Corporation

SWEPCO Distributor Application Form

PLEASE COMPLETE THIS APPLICATION ONLY IF YOU DO NOT LIVE IN THE UNITED STATES, CANADA OR EUROPE

YOUR CONTACT INFORMATION:

FINANCIAL INFORMATION (please list figures in US dollars)

YOUR COMPANY INFORMATION:

SALES EXPERIENCE:

Heavy Construction

Mining

Manufacturing

Marine

Transportation

About SWEPCO

Services

Industries Served

Join Our Team

Southwestern Petroleum Corporation

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SWEPCO Distributor Application Form

PLEASE COMPLETE THIS APPLICATION ONLY IF YOU DO NOT LIVE IN THE UNITED STATES, CANADA OR EUROPE

YOUR CONTACT INFORMATION:

FINANCIAL INFORMATION (please list figures in US dollars)

YOUR COMPANY INFORMATION:

SALES EXPERIENCE:

Heavy Construction

Mining

Manufacturing

Marine

Transportation

About SWEPCO

Services

Industries Served

Join Our Team