Form of partnership

Would you like to offer one of our products in your shop?
Fill in the form below, we will reply to all your questions as soon as possible.

Personal data

Name* :		First name* :
Address* :		N°* :
Post Code* :		Location* :
Country* :
Home phone :		Mobile phone :
Office phone :
Fax :
E-mail* :
Verification code :
Please re-enter your code* :

Current professional status

Profession* :
Company* :
Sector of activity* :

Professional experience

Have you already been self-employed?	Yes No
If yes, for which product?
Have you already been a partner?	Yes No
If yes, for which company?

Additional information

As a partner, do you want :	To take over an existing commercial area?
	To open a new sales outlet?

What capital is available to you to become one of our partners?*
Do you have a sales area available to you?*
If yes, please tell us the area and the location.

If no, in which region do you want to become established? * Indicate 2 regions in order of preference.

Region 1.

Region 2.

When would you like to start your partnership business?*

3 months 6 months 9 months 12 months a year

You are interested in :

Pralines in bulk Pre-packed boxes Others :

Reasons

What drew you to Kim's Chocolates N.V.?

Description of your project :

Do you have any questions? Please don’t hesitate to record them in the box below.

*Compulsory fields. Your data is strictly confidential and will, under no circumstances, be transmitted to any third parties.