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Become a Distributor

Globe Scientific's products are sold through distribution channels throughout the world. If you are interested in representing our product line in your area, please fill out the distributor application below.

 U.S Dealer  International Dealer
* Required information
Contact Information:
First Name:    *
Last Name:    *
Title:    *
Street Address:    *
Address Line 2:  
City:    *
State/Province:    *
Post/Zip Code:    *
Country:    *
Telephone Number:    *
Fax Number:    *
E-Mail Address:    *
Company Information:
Company Name:    *
Website:    *
Date Established:    *
Annual Sales:(U.S. Dollars)    *
Federal ID#:(Applies to U.S.A.Dealers Only)    
Resale Certificate#:(Applies to U.S.A.Dealers Only)    
President Name:    *
President Phone:    *
President Email:    *
Vice President Name:    
Vice President Phone:    
Vice President Email:    
Chief Financial Officer Name:    
Chief Financial Officer Phone:    
Chief Financial Officer Email:    
Important Contacts:
Purchasing Name:    
Purchasing Phone:    
Purchasing Email:    
Accounts Payable Name:    
Accounts Payable Phone:    
Accounts Payable Email:    
Sales Manager Name:    
Sales Manager Phone:    
Sales Manager Email:    
Marketing Manager Name:    
Marketing Manager Phone:    
Marketing Manager Email:    
Purchasing/Sales/Marketing Information
Primary Product Line:*
Distributors Laboratories Government Doctors Hospitals Industrial Other
Primary Customers Served:*
Geographical Area Served: *
List Area Competitors:*
CHECK if you currently purchase laboratory plasticware from other suppliers.
If yes, what is your annual purchase amount? *
Who are your key suppliers of lab plasticware?*
Globe Scientific products of interest:*
Anticipated annual purchases of Globe products: *
Major Means of Promotion:*
Number of Outside Salesmen:     *
Number of Inside Telemarketers: *