Distributor Entry Form - POCT CLIA Analyzer Inquiry Form

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Distributor Entry Form for POCT CLIA Analyzer

Thank you for your interest in becoming a distributor for our POCT CLIA Analyzer. Please fill in the details below:

Basic Information - Step 1 of 2

Name *

First

Last

Company Name

Email *

Phone / whatsapp *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Upload Your Company Registration Certificate *

Trade License/ GST etc.

Service you (Last

Upload your drug license/ drug related certificates *

Total Experience *

Location you like to work (Please Specify City/State) *

Total Sales Employees

Total Service Support Engineers

Annual Turnover (Last FY)

Experience with Similar Products

sale and market any poct immunoassay analyzer?

Are you interested in? *

Sub Distributor
Distributor
C&F

click any one

TERMS AND CONDITIONS *

I Agree

Terms and Conditions

This agreement ("Agreement") is made and entered into by Quicklab Services Private Limited ("Company") and the distributor ("Distributor") upon submission of the Distributor Inquiry Form. By submitting the form, the Distributor agrees to be bound by the following terms and conditions:

1. Appointment of Distributor

1.1 The submission of the Distributor Inquiry Form does not constitute an agreement of distributorship. The Company reserves the right to evaluate and approve all applications.
1.2 Upon approval, a separate distributorship agreement will be executed to formalize the relationship.

2. Distributor Obligations

2.1 The Distributor shall:

Provide accurate and complete information in the inquiry form.

Comply with all applicable laws, regulations, and industry standards.

Promote and sell the Company's products within the assigned territory.
2.2 Any false or misleading information in the inquiry form may result in immediate rejection of the application or termination of any agreement.

3. Company's Obligations

3.1 The Company agrees to:

Evaluate the Distributor's inquiry form in a timely manner.

Provide product details, pricing, and terms upon approval of distributorship.

Offer training and support to the Distributor as outlined in the formal agreement.

4. Confidentiality

4.1 The Distributor shall treat all information provided by the Company as confidential and shall not disclose such information to any third party without prior written consent.

5. Intellectual Property

5.1 All trademarks, logos, and branding related to the Company's products remain the exclusive property of the Company.
5.2 The Distributor is granted a limited, non-exclusive license to use the Company's trademarks solely for the purpose of promoting and selling the Company's products.

6. Termination

6.1 This Agreement shall automatically terminate upon rejection of the inquiry form or upon execution of a formal distributorship agreement.
6.2 The Company may terminate this Agreement at its sole discretion if the Distributor violates any term herein.

7. Limitation of Liability

7.1 The Company shall not be liable for any direct, indirect, or consequential losses incurred by the Distributor unless otherwise stated in a formal distributorship agreement.

8. Governing Law and Jurisdiction

8.1 This Agreement shall be governed by and construed in accordance with the laws of [Jurisdiction], and any disputes shall be subject to the exclusive jurisdiction of the courts of Chennai.

9. Amendments

9.1 The Company reserves the right to amend these terms and conditions at any time. Such amendments shall be effective immediately upon notice to the Distributor.

10. Acceptance

10.1 By submitting the Distributor Inquiry Form, the Distributor acknowledges and accepts these terms and conditions in full.

Authorized Representative
Quicklab Services Private Limited

B. Palani Muthu
National Sales Manager

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