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Contact Us > Agent & Distributor Form

Agent & Distributor Form

At Nutrex, we are constantly searching for new partners in several countries worldwide, to work together with us in close cooperation.

If you are convinced of the quality of Nutrex' products and are interested in a productive cooperation between your company and Nutrex, please fill out our agent and distributor's information form below and provide us with as much data as possible for maximum efficiency.

Mandatory information fields are indicated with (*).

Upon reception of your form, we will study your data and get in touch with you as soon as possible to discuss possible ways of working together.

Title (*)
First Name (*)
Last Name (*)
Function (*)
Company Name (*)
Address Line 1
Address Line 2
Postal Code
Country (*)
Phone Number (*) (incl. country & area code)
Fax Number (incl. country & area code)
E-mail Address (*) (valid e-mail address required)
Sales people (dedicated to additive sales)
Core activities (*)

(multiple selections
possible by holding
the CTRL-key down)
Other activities
Current agencies

Countries served (*)
Products handled (*)
Products seeking (*)
Other Products
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