INTERNATIONAL DISTRIBUTOR QUESTIONNAIRE INFINITY SAV

INTERNATIONAL DISTRIBUTOR QUESTIONNAIRE

The following information must be provided in order to be considered as a distributor of Infinity SAV products.
Please provide as much information as possible.

PLEASE NOTE: THIS QUESTIONNAIRE DOES NOT CONSTITUTE A CONTRACT OR ANY OFFER FOR
DISTRIBUTORSHIP. INFINITY SAV RESERVES THE RIGHT TO ACCEPT OR REJECT THIS QUESTIONNAIRE
AT ITS DISCRETION.

I. COMPANY INFORMATION

Company Name: PT. Global Mekar Mandiri (GM2)

Street Address: Komplek. Bumi Panyawangan Cluster Mahoni Jl. Mahoni Aseri2
No.11 Cileunyi
City/State/Province: Kab.Bandung Jawa barat (West Java)
Country: Indonesia _
Telephone Number: +62 - 8123459529
Country Code Main Number Extension, if any

Person to Contact: Rudi Rahamat Mulyana

Title: Commisaris
E-mail Address: mnrjhn08@gmail.com
Mobile Number: 08123459529
Company Website:
Please indicate below, your type of business:

Manufacturer Distributor
Broker/Trading Company Marketing Company Other describe below
Contractor and consultant

The territory / country you would like to represent Indonesia

INTERNATIONAL DISTRIBUTOR QUESTIONNAIRE INFINITY SAV

II. ORGANIZATION

1) What year was your business established? 2001

2) How many people does your company employ? 15

3) How many sales representatives are in your company? 5

4) Does your company sell through independent sales representatives, agents or

distributors?
YES NO
If yes, please provide a brief explanation of the number and type of other sales:

Please fill out the Distributor's Questionnaire and send it to us by e-mail

distributor@infinitysav.com

Thank you for taking the time to complete this Questionnaire. It is important to us
to insure that our distributors are knowledgeable of the market, experienced in sales and
marketing, and financially secure to properly support the process.

Upon reviewing your information, we will contact you as soon as possible.

We will send you a draft of distributorship agreement.
Please do not hesitate to contact us if you have any questions or comments.