PROVIDING DISTRIBUTORS STATE OF THE ART PROFESSIONAL WHITENING TECHNOLOGY Distributors in any market are always seeking newer a better products that can enhance their business relationships and generate new profits. Liquid Smile is the new product you have been searching for. State of the art whitening. Professional strength, available only through dental and medical professionals. And an affordable product that more of your clients can offer to more of their patients and consumers. We welcome your interest in becoming an authorized Liquid Smile® distributor. Please fill out the qualifying form below and submit it. We will contact you shortly to discuss how you can represent the fastest-growing professional whitening product in the industry. Distributor Interest Form Corporate Information Name of Company: Address: Phone: Fax: Web: Email: President: Vice President: # of Employees: # of Locations: # of Inside Sales Reps: # of Outside Sales Reps: Marketing Information Which is Your Market?. Dental Med-Spa/Medical Does your company produce a yearly catalog? Yes No Does your company produce regularly scheduled flyers? Yes No Does your company have an email campaign? Yes No Does your company attend trade shows? Yes No Primary Market Area: West Southwest Midwest Mideast   Northeast Southeast International   Estimate of your ACTIVE customer base < 1000 1000-2500   2500-5000 5000-10000   >10000   List your three most direct competitors Distribution Information What is your Distribution Channel for Liquid Smile? (select all that apply) Retail Dental Community Med Spa Community Television Internet   How will you position Liquid Smile? (Select all that apply) Cosmetic Product Dental Product Medical Product To What Market do you currently Distribute? (select all that apply) Retail Dental Professionals Medical Professionals Med Spas Salons and Day Spas Optometry Professionals Other (Specify) Do you distribute to foreign markets? No Yes. If yes, select countries Product Information Do you currently represent a teeth whitening product? No Yes If yes, which product(s) What is your best selling whitener or cosmetic? What is your second best selling whitener or cosmetic? How did you hear about Liquid Smile? Please call 888.954.7843 if you have any questions.   Distributors | Terms & Conditions | Site map| Contact Us