Distributor Application Form

Below is a professional, ready-to-use Distributor Application Form for Crown Organic Biofertilizers Inc. (COBI).
This is aligned with your Dealer Code of Conduct, Territory Exclusivity Policy, Minimum Purchase Commitment Schedule, and Distributor Pitch Deck, and can be used in print, PDF, or online form formats.

📄 COBI DISTRIBUTOR APPLICATION FORM

Crown Organic Biofertilizers Inc. (COBI)
Authorized Distributor / Dealer / Extension Partner

SECTION 1: APPLICANT INFORMATION

Business Name: ___________________________________________
Business Address: ________________________________________

Type of Entity:
☐ Sole Proprietorship
☐ Partnership
☐ Corporation
☐ Cooperative
☐ Other: ___________________

Year Established: ___________
DTI / SEC / CDA Registration No.: ___________________________

SECTION 2: CONTACT PERSON

Full Name: _______________________________________________
Position / Title: _________________________________________
Mobile No.: ______________________________________________
Email Address: ___________________________________________

Alternate Contact Person (if any): __________________________
Mobile / Email: ___________________________________________

SECTION 3: DISTRIBUTION DETAILS

Applying As:
☐ Barangay / Cluster Dealer
☐ Municipal / City Exclusive Dealer
☐ Provincial Exclusive Distributor
☐ Regional / Master Distributor

Requested Territory (Barangay / City / Province / Region):

Is this territory currently served by another distributor?
☐ Yes ☐ No ☐ Not Sure

SECTION 4: BUSINESS CAPABILITY PROFILE

Years of experience in agri-inputs / farm supplies:
☐ Less than 1 year
☐ 1–3 years
☐ 4–7 years
☐ 8+ years

Current Product Lines Handled (brands & categories):

Do you currently handle competing biofertilizer brands?
☐ Yes ☐ No
If yes, please specify: _______________________________________

SECTION 5: SALES & MARKET REACH

Primary Customer Segments (check all that apply):
☐ Smallholder farmers
☐ Commercial farms / plantations
☐ Cooperatives / associations
☐ LGUs / government projects
☐ NGOs / institutions

Estimated Monthly Sales Volume (Agri-inputs):
☐ Below ₱50,000
☐ ₱50,000 – ₱150,000
☐ ₱150,000 – ₱300,000
☐ ₱300,000+

SECTION 6: LOGISTICS & OPERATIONS

Warehouse / Storage Facility:
☐ Owned ☐ Rented ☐ None

Location: _______________________________________________

Delivery Capability:
☐ Own vehicle(s)
☐ Third-party logistics
☐ Pick-up only

SECTION 7: MARKETING & FIELD SUPPORT CAPABILITY

Please indicate available capabilities:

☐ Sales agents / field technicians
☐ Demo plot establishment
☐ Farmer trainings / seminars
☐ Social media / digital marketing
☐ LGU / coop partnerships

Briefly describe your marketing approach:

SECTION 8: FINANCIAL & COMMITMENT DECLARATION

Proposed Initial Stocking Order (₱): _______________________

Target Monthly / Quarterly Purchase Commitment:

☐ I acknowledge and agree to comply with COBI’s Minimum Purchase Commitment Schedule

SECTION 9: COMPLIANCE & DECLARATIONS

Please check all boxes to proceed:

☐ I agree to comply with the COBI Dealer Code of Conduct
☐ I agree to adhere to territory, pricing, and branding policies
☐ I understand that exclusivity is performance-based
☐ I consent to background verification and reference checks

SECTION 10: REFERENCES (OPTIONAL BUT RECOMMENDED)

Business Reference #1
Name / Company: ___________________________________________
Contact No.: _______________________________________________

Business Reference #2
Name / Company: ___________________________________________
Contact No.: _______________________________________________

SECTION 11: SIGNATURE & CERTIFICATION

I hereby certify that the information provided is true and correct. I understand that submission of this application does not guarantee approval or exclusivity, and that COBI reserves the right to accept or reject applications at its discretion.

Authorized Signatory Name: _______________________________
Signature: ___________________________ Date: _____________

FOR COBI INTERNAL USE ONLY

Evaluation Result:
☐ Approved
☐ Approved with Conditions
☐ Deferred
☐ Rejected

Assigned Territory: ______________________________________
Approved Distributor Level: ______________________________
Initial Commitment: ₱____________________________________

Reviewed by: _____________________ Date: ________________

🌱 COBI DISTRIBUTOR PRINCIPLE

Capability. Commitment. Compliance.

🔜 NEXT DOCUMENTS I CAN PREPARE FOR YOU

  • Distributor Evaluation Scorecard (weighted, decision-ready)
  • Approval Letter & Welcome Kit
  • Distributor Onboarding Checklist (30–60–90 day plan)
  • Digital version (Google Form / fillable PDF)
  • Full COBI Distributor Handbook (all policies consolidated)

Just tell me what you want next and I’ll finalize it.