Distributor Data Update Form

Changes to your distributor's information can now be conveniently handled online with the Distributor Data Update Form below. Simply follow the instructions provided below and Marketing will take care of the rest. It's really that easy!

REGIONAL MANAGER INSTRUCTION
1) Complete this form to either ADD a distributor or distributor branch's information.
NOTE: Marketing will include you (CC:) on all related correspondence with distributor contacts.

IMPORTANT: This form is for Wilden Regional Managers Only. If you are a distributor, please update your information on the Distributor Update Web-Form linked here.
FORM AUTHORIZATION
     
*Submitted By  
*Position  
*Form Purpose  
*Effective Change Date  
   
DISTRIBUTOR/BRANCH CONTACT INFORMATION
     
*Distributor's
Company Name		  
*Location Type

 
*Distributor ID #
Mandatory if  www.teamwilden.com  access is required

 
     
  *MAILING ADDRESS   *SHIPPING ADDRESS
*Address Line 1 *Address Line 1
Address Line 2 Address Line 2
*City
*City
*State /Province
*State /Province
*Zip/Postal Code *Zip/Postal Code
*Country *Country
   
Website
   
General Email
     
     
*Main Phone          
*Main Fax          
Sales Phone          
Sales Fax          
Accounting/Invoicing
Phone		          
*Accounting/Invoicing
Email		          
 
DISTRIBUTOR/BRANCH PMA DETAILS
   
*Assigned Region  
*Regional Manager's
Full Name		    
*Primary Market Areas 1)
i.e. California Area 2, Florida Area 1 		   
2)    
3)    
4)    
5)    
6)    
   
*Authorized to sell Wilden
Typhoon
Spectrom
OEM Account 		Unitec
Saniflo
BioPharm
Other

     
     
*Shared PMA
NO
 

Special PMA Conditions
     
COMPANY ROSTER - KEY CONTACT
*First Name *Direct Phone
*Last Name *Fax
*Position Cell
*Email Address    
       
*Access and Memberships
DVT member** Literature**
Teamwilden- Acct Mngr Receives-TB's
Teamwilden-Approved Receives-TGIF email
Partner Portal Access** Receives-the EDGE
Receives - Misc. leads  
 
 
 
 
  **Limited to one (1) contact per company
 
 
COMPANY ROSTER - OTHER CONTACTS
 
First Name Direct Phone
Last Name Fax
Position Cell
Email Address Alternate Email
       
 
Contact Type
Key Contact*+ Sales
Secondary Contact Distributor employee
Branch Mngr*+ Subdistributor**
Branch Mngr Asst. Other:
Acctg Contact*+
Access and Memberships+
DVT member** Literature**
Teamwilden- Acct Mngr Receives-TB's
Teamwilden-Approved Receives-TGIF email
Partner Portal Access** Receives-the EDGE
Receives - Misc. leads CVT member
 
 
 
    *Limited to one (1) contact per company
**Cannot be granted access to price/discount information
+Contact must have a valid email address
   
   
First Name Direct Phone
Last Name Fax
Position Cell
Email Address Alternate Email
       
 
Contact Type
Key Contact*+ Sales
Secondary Contact Distributor employee
Branch Mngr*+ Subdistributor**
Branch Mngr Asst. Other:
Acctg Contact*+
Access and Memberships+
DVT member** Literature**
Teamwilden- Acct Mngr Receives-TB's
Teamwilden-Approved Receives-TGIF email
Partner Portal Access** Receives-the EDGE
Receives - Misc. leads CVT member
 
 
 
  *Limited to one (1) contact per company
**Cannot be granted access to price/discount information
+Contact must have a valid email address
   
   
First Name Direct Phone
Last Name Fax
Position Cell
Email Address Alternate Email
       
 
Contact Type
Key Contact*+ Sales
Secondary Contact Distributor employee
Branch Mngr*+ Subdistributor**
Branch Mngr Asst. Other:
Acctg Contact*+
Access and Memberships+
DVT member** Literature**
Teamwilden- Acct Mngr Receives-TB's
Teamwilden-Approved Receives-TGIF email
Partner Portal Access** Receives-the EDGE
Receives - Misc. leads CVT member
 
 
 
  *Limited to one (1) contact per company
**Cannot be granted access to price/discount information
+Contact must have a valid email address
   
   
First Name Direct Phone
Last Name Fax
Position Cell
Email Address Alternate Email
       
 
Contact Type
Key Contact*+ Sales
Secondary Contact Distributor employee
Branch Mngr*+ Subdistributor**
Branch Mngr Asst. Other:
Acctg Contact*+
Access and Memberships+
DVT member** Literature**
Teamwilden- Acct Mngr Receives-TB's
Teamwilden-Approved Receives-TGIF email
Partner Portal Access** Receives-the EDGE
Receives - Misc. leads CVT member
 
 
 
  *Limited to one (1) contact per company
**Cannot be granted access to price/discount information
+Contact must have a valid email address
   
   
First Name Direct Phone
Last Name Fax
Position Cell
Email Address Alternate Email
       
 
Contact Type
Key Contact*+ Sales
Secondary Contact Distributor employee
Branch Mngr*+ Subdistributor**
Branch Mngr Asst. Other:
Acctg Contact*+
Access and Memberships+
DVT member** Literature**
Teamwilden- Acct Mngr Receives-TB's
Teamwilden-Approved Receives-TGIF email
Partner Portal Access** Receives-the EDGE
Receives - Misc. leads CVT member
 
 
 
  *Limited to one (1) contact per company
**Cannot be granted access to price/discount information
+Contact must have a valid email address