Distributor Request Form

Please complete this form so we can learn more about you.  Contact sales@rowheels.com if you have any specific questions. The ROWHEELS Revolution 1.9 wheelchair will start shipping in Mid 2019. Internationally shipments will commence  after that date.

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* 1. Please complete the details below

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* 2. What is the URL of the company website?

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* 3. What is the company's annual revenue in US Dollars?

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* 4. Which wheelchair brands do you currently represent?

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* 5. In which geographic regions would you want to sell ROWHEELS products?

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