{"id":5818,"date":"2021-02-03T00:34:43","date_gmt":"2021-02-03T00:34:43","guid":{"rendered":"https:\/\/www.cubeatomizers.com\/?page_id=5818"},"modified":"2021-02-03T00:57:17","modified_gmt":"2021-02-03T00:57:17","slug":"become-distributor","status":"publish","type":"page","link":"https:\/\/www.cubeatomizers.com\/ro\/become-distributor\/","title":{"rendered":"Become distributor"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"5818\" class=\"elementor elementor-5818\" data-elementor-settings=\"[]\">\n\t\t\t\t\t\t\t<div class=\"elementor-section-wrap\">\n\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-8b21aa4 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"8b21aa4\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-c76b63b\" data-id=\"c76b63b\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-32644d5 elementor-widget elementor-widget-text-editor\" data-id=\"32644d5\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\"><p>Distributor Application Online Form<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-368864f elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"368864f\" data-element_type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;step_type&quot;:&quot;text&quot;,&quot;button_width&quot;:&quot;100&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"New Form\" action=\"\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"5818\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"368864f\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"\" \/>\n\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_f4a9535 elementor-col-100\">\n\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Personal Detalis\" data-previousbutton=\"Back\" data-nextbutton=\"Next\" data-iconurl=\"\" data-iconlibrary=\"fas fa-star\"><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_1e2a40e elementor-col-100\">\n\t\t\t\t\tPLEASE FILL IN EACH FIELD IN THE FORM BELOW:<br\/>\nYour personal information will only be used for contacting you regarding your application. We will not share this information with any third parties.\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-name elementor-col-100\">\n\t\t\t\t\t<label for=\"form-field-name\" class=\"elementor-field-label\">Your Title<\/label><div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Mr\" id=\"form-field-name-0\" name=\"form_fields[name][]\"> <label for=\"form-field-name-0\">Mr<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Mrs\" id=\"form-field-name-1\" name=\"form_fields[name][]\"> <label for=\"form-field-name-1\">Mrs<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Ms\" id=\"form-field-name-2\" name=\"form_fields[name][]\"> <label for=\"form-field-name-2\">Ms<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Miss\" id=\"form-field-name-3\" name=\"form_fields[name][]\"> <label for=\"form-field-name-3\">Miss<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_1be41ec elementor-col-50\">\n\t\t\t\t\t<label for=\"form-field-field_1be41ec\" class=\"elementor-field-label\">Other [please specify] :<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_1be41ec]\" id=\"form-field-field_1be41ec\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_53bfc33 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t<label for=\"form-field-field_53bfc33\" class=\"elementor-field-label\">Home Address: <\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_53bfc33]\" id=\"form-field-field_53bfc33\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_2f1bf0e elementor-col-50 elementor-field-required\">\n\t\t\t\t\t<label for=\"form-field-field_2f1bf0e\" class=\"elementor-field-label\">First Name:<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_2f1bf0e]\" id=\"form-field-field_2f1bf0e\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_b1b8cb3 elementor-col-25 elementor-field-required\">\n\t\t\t\t\t<label for=\"form-field-field_b1b8cb3\" class=\"elementor-field-label\">Country<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_b1b8cb3]\" id=\"form-field-field_b1b8cb3\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_ef96088 elementor-col-25 elementor-field-required\">\n\t\t\t\t\t<label for=\"form-field-field_ef96088\" class=\"elementor-field-label\">Zip\/Postcode<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_ef96088]\" id=\"form-field-field_ef96088\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_d060a80 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t<label for=\"form-field-field_d060a80\" class=\"elementor-field-label\">Last Name:<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_d060a80]\" id=\"form-field-field_d060a80\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_4291fb0 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t<label for=\"form-field-field_4291fb0\" class=\"elementor-field-label\">Personal Email:<\/label><input size=\"1\" type=\"email\" name=\"form_fields[field_4291fb0]\" id=\"form-field-field_4291fb0\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_92b4b1f elementor-col-50\">\n\t\t\t\t\t<label for=\"form-field-field_92b4b1f\" class=\"elementor-field-label\">Personal Phone:<\/label><input size=\"1\" type=\"tel\" name=\"form_fields[field_92b4b1f]\" id=\"form-field-field_92b4b1f\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_4eda2fb elementor-col-50 elementor-field-required\">\n\t\t\t\t\t<label for=\"form-field-field_4eda2fb\" class=\"elementor-field-label\">Personal Mobile:<\/label><input size=\"1\" type=\"tel\" name=\"form_fields[field_4eda2fb]\" id=\"form-field-field_4eda2fb\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_da24829 elementor-col-100\">\n\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Business Detalis\" data-previousbutton=\"Back\" data-nextbutton=\"Next\" data-iconurl=\"\" data-iconlibrary=\"fas fa-star\"><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_60df206 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t<label for=\"form-field-field_60df206\" class=\"elementor-field-label\">Business Name:<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_60df206]\" id=\"form-field-field_60df206\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_ee9b4cb elementor-col-50 elementor-field-required\">\n\t\t\t\t\t<label for=\"form-field-field_ee9b4cb\" class=\"elementor-field-label\">Current Sales Region \/ Territory:<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_ee9b4cb]\" id=\"form-field-field_ee9b4cb\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_a70d5b2 elementor-col-50\">\n\t\t\t\t\t<label for=\"form-field-field_a70d5b2\" class=\"elementor-field-label\">Registered Name [if different] :<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_a70d5b2]\" id=\"form-field-field_a70d5b2\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_77b256f elementor-col-50\">\n\t\t\t\t\t<label for=\"form-field-field_77b256f\" class=\"elementor-field-label\">Your Relationship to the Business:<\/label><div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Business Owner \" id=\"form-field-field_77b256f-0\" name=\"form_fields[field_77b256f][]\"> <label for=\"form-field-field_77b256f-0\">Business Owner <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Director \/ Partner \/ Member\" id=\"form-field-field_77b256f-1\" name=\"form_fields[field_77b256f][]\"> <label for=\"form-field-field_77b256f-1\">Director \/ Partner \/ Member<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"25% [or over] Shareholder \" id=\"form-field-field_77b256f-2\" name=\"form_fields[field_77b256f][]\"> <label for=\"form-field-field_77b256f-2\">25% [or over] Shareholder <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Appointed Representative\" id=\"form-field-field_77b256f-3\" name=\"form_fields[field_77b256f][]\"> <label for=\"form-field-field_77b256f-3\">Appointed Representative<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_2f9edbe elementor-col-50 elementor-field-required\">\n\t\t\t\t\t<label for=\"form-field-field_2f9edbe\" class=\"elementor-field-label\">Registered Address :<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_2f9edbe]\" id=\"form-field-field_2f9edbe\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_a5b491f elementor-col-50 elementor-field-required\">\n\t\t\t\t\t<label for=\"form-field-field_a5b491f\" class=\"elementor-field-label\">How much of the business do you own? :<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_a5b491f]\" id=\"form-field-field_a5b491f\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"100%\" required=\"required\" aria-required=\"true\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_42975f4 elementor-col-25 elementor-field-required\">\n\t\t\t\t\t<label for=\"form-field-field_42975f4\" class=\"elementor-field-label\">Country:<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_42975f4]\" id=\"form-field-field_42975f4\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_2458e62 elementor-col-25 elementor-field-required\">\n\t\t\t\t\t<label for=\"form-field-field_2458e62\" class=\"elementor-field-label\">Zip\/Postcode:<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_2458e62]\" id=\"form-field-field_2458e62\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-number elementor-field-group elementor-column elementor-field-group-field_45bedc4 elementor-col-25 elementor-field-required\">\n\t\t\t\t\t<label for=\"form-field-field_45bedc4\" class=\"elementor-field-label\">How long have you been trading? <\/label><input type=\"number\" name=\"form_fields[field_45bedc4]\" id=\"form-field-field_45bedc4\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Years\" required=\"required\" aria-required=\"true\" min=\"\" max=\"\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_223b388 elementor-col-25\">\n\t\t\t\t\t<label for=\"form-field-field_223b388\" class=\"elementor-field-label\">.<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_223b388]\" id=\"form-field-field_223b388\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Months\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_9e3d466 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t<label for=\"form-field-field_9e3d466\" class=\"elementor-field-label\">Email Adress:<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_9e3d466]\" id=\"form-field-field_9e3d466\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-number elementor-field-group elementor-column elementor-field-group-field_3258f67 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t<label for=\"form-field-field_3258f67\" class=\"elementor-field-label\">Percent of Business Related to medical \/ disinfection equipment?<\/label><input type=\"number\" name=\"form_fields[field_3258f67]\" id=\"form-field-field_3258f67\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"60%\" required=\"required\" aria-required=\"true\" min=\"\" max=\"\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_d76e4e7 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t<label for=\"form-field-field_d76e4e7\" class=\"elementor-field-label\">Phone Number:<\/label><input size=\"1\" type=\"tel\" name=\"form_fields[field_d76e4e7]\" id=\"form-field-field_d76e4e7\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_e5bd3b5 elementor-col-25 elementor-field-required\">\n\t\t\t\t\t<label for=\"form-field-field_e5bd3b5\" class=\"elementor-field-label\">No. Employees:<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_e5bd3b5]\" id=\"form-field-field_e5bd3b5\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_4f87ea2 elementor-col-25 elementor-field-required\">\n\t\t\t\t\t<label for=\"form-field-field_4f87ea2\" class=\"elementor-field-label\">No. Stores\/Dealers:<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_4f87ea2]\" id=\"form-field-field_4f87ea2\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_28ff969 elementor-col-50\">\n\t\t\t\t\t&nbsp;\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_ee6da2a elementor-col-50\">\n\t\t\t\t\t<label for=\"form-field-field_ee6da2a\" class=\"elementor-field-label\">Current Brand Offering:<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_ee6da2a]\" id=\"form-field-field_ee6da2a\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_f2b383d elementor-col-50\">\n\t\t\t\t\t&nbsp;\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_c9ad178 elementor-col-50\">\n\t\t\t\t\t<label for=\"form-field-field_c9ad178\" class=\"elementor-field-label\">Current Sales Channels :  <\/label><div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Industry [B2B] \" id=\"form-field-field_c9ad178-0\" name=\"form_fields[field_c9ad178][]\"> <label for=\"form-field-field_c9ad178-0\">Industry [B2B] <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Retail Store \" id=\"form-field-field_c9ad178-1\" name=\"form_fields[field_c9ad178][]\"> <label for=\"form-field-field_c9ad178-1\">Retail Store <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Online Store\" id=\"form-field-field_c9ad178-2\" name=\"form_fields[field_c9ad178][]\"> <label for=\"form-field-field_c9ad178-2\">Online Store<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Online Marketplace \" id=\"form-field-field_c9ad178-3\" name=\"form_fields[field_c9ad178][]\"> <label for=\"form-field-field_c9ad178-3\">Online Marketplace <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Healthcare \" id=\"form-field-field_c9ad178-4\" name=\"form_fields[field_c9ad178][]\"> <label for=\"form-field-field_c9ad178-4\">Healthcare <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Horeca\" id=\"form-field-field_c9ad178-5\" name=\"form_fields[field_c9ad178][]\"> <label for=\"form-field-field_c9ad178-5\">Horeca<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Automotive\" id=\"form-field-field_c9ad178-6\" name=\"form_fields[field_c9ad178][]\"> <label for=\"form-field-field_c9ad178-6\">Automotive<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_9b6b7e9 elementor-col-50\">\n\t\t\t\t\t&nbsp;\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_01b3014 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t<label for=\"form-field-field_01b3014\" class=\"elementor-field-label\">Nature of the Business:<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_01b3014]\" id=\"form-field-field_01b3014\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_1c31c8f elementor-col-100\">\n\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\" QUALIFIED DISTRIBUTOR OPPORTUNITY\" data-previousbutton=\"Back\" data-nextbutton=\"Next\" data-iconurl=\"\" data-iconlibrary=\"fas fa-star\"><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_a691a7c elementor-col-50 elementor-field-required\">\n\t\t\t\t\t<label for=\"form-field-field_a691a7c\" class=\"elementor-field-label\">Where did you hear of Cube Atomizers?<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_a691a7c]\" id=\"form-field-field_a691a7c\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_8e187a9 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t<label for=\"form-field-field_8e187a9\" class=\"elementor-field-label\">Desired Sales Region \/ Territory:<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_8e187a9]\" id=\"form-field-field_8e187a9\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_3dffb22 elementor-col-50\">\n\t\t\t\t\t<label for=\"form-field-field_3dffb22\" class=\"elementor-field-label\">Do you have experience of medical \/ disinfection equipment and their use? <\/label><div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Yes\" id=\"form-field-field_3dffb22-0\" name=\"form_fields[field_3dffb22][]\"> <label for=\"form-field-field_3dffb22-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"No\" id=\"form-field-field_3dffb22-1\" name=\"form_fields[field_3dffb22][]\"> <label for=\"form-field-field_3dffb22-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_93f9a81 elementor-col-50\">\n\t\t\t\t\t<label for=\"form-field-field_93f9a81\" class=\"elementor-field-label\">Do you already have potential orders for the Cube Atomizers equipment? <\/label><div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Yes\" id=\"form-field-field_93f9a81-0\" name=\"form_fields[field_93f9a81][]\"> <label for=\"form-field-field_93f9a81-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"No\" id=\"form-field-field_93f9a81-1\" name=\"form_fields[field_93f9a81][]\"> <label for=\"form-field-field_93f9a81-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_c7c7795 elementor-col-50\">\n\t\t\t\t\t<label for=\"form-field-field_c7c7795\" class=\"elementor-field-label\">If yes, which manufacturers\/products? [please specify] :<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_c7c7795]\" id=\"form-field-field_c7c7795\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-number elementor-field-group elementor-column elementor-field-group-field_f1ecb38 elementor-col-25 elementor-field-required\">\n\t\t\t\t\t<label for=\"form-field-field_f1ecb38\" class=\"elementor-field-label\">Please estimate number of units required as opening order :<\/label><input type=\"number\" name=\"form_fields[field_f1ecb38]\" id=\"form-field-field_f1ecb38\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Units\" required=\"required\" aria-required=\"true\" min=\"\" max=\"\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-number elementor-field-group elementor-column elementor-field-group-field_6604ecc elementor-col-25 elementor-field-required\">\n\t\t\t\t\t<label for=\"form-field-field_6604ecc\" class=\"elementor-field-label\">Please estimate your forecasted sales per annum : <\/label><input type=\"number\" name=\"form_fields[field_6604ecc]\" id=\"form-field-field_6604ecc\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Units\" required=\"required\" aria-required=\"true\" min=\"\" max=\"\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_8ead6c3 elementor-col-100\">\n\t\t\t\t\t<label for=\"form-field-field_8ead6c3\" class=\"elementor-field-label\">Any additional requirements? :  <\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_8ead6c3]\" id=\"form-field-field_8ead6c3\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_513cc32 elementor-col-100\">\n\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"TRADE REFERENCES\" data-previousbutton=\"Back\" data-nextbutton=\"Next\" data-iconurl=\"\" data-iconlibrary=\"fas fa-star\"><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_dfcc555 elementor-col-100\">\n\t\t\t\t\tIf you don't have any references or do not wish to disclose this kind of information, you may skip this step by leaving all the fields empty.\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_6ea830d elementor-col-50\">\n\t\t\t\t\t<label for=\"form-field-field_6ea830d\" class=\"elementor-field-label\">Supplier Name :<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_6ea830d]\" id=\"form-field-field_6ea830d\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_0876b22 elementor-col-50\">\n\t\t\t\t\t<label for=\"form-field-field_0876b22\" class=\"elementor-field-label\">Supplier Name :<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_0876b22]\" id=\"form-field-field_0876b22\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_1d3858f elementor-col-50\">\n\t\t\t\t\t<label for=\"form-field-field_1d3858f\" class=\"elementor-field-label\">Start Date :<\/label><input type=\"date\" name=\"form_fields[field_1d3858f]\" id=\"form-field-field_1d3858f\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_0f6cf23 elementor-col-50\">\n\t\t\t\t\t<label for=\"form-field-field_0f6cf23\" class=\"elementor-field-label\">Start Date :<\/label><input type=\"date\" name=\"form_fields[field_0f6cf23]\" id=\"form-field-field_0f6cf23\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_1690fc0 elementor-col-50\">\n\t\t\t\t\t<label for=\"form-field-field_1690fc0\" class=\"elementor-field-label\">Supplier Address :<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_1690fc0]\" id=\"form-field-field_1690fc0\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_a4ef217 elementor-col-50\">\n\t\t\t\t\t<label for=\"form-field-field_a4ef217\" class=\"elementor-field-label\">Supplier Address :<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_a4ef217]\" id=\"form-field-field_a4ef217\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_1274054 elementor-col-25\">\n\t\t\t\t\t<label for=\"form-field-field_1274054\" class=\"elementor-field-label\">Country:<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_1274054]\" id=\"form-field-field_1274054\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_75eb818 elementor-col-25\">\n\t\t\t\t\t<label for=\"form-field-field_75eb818\" class=\"elementor-field-label\">Zip\/Postcode<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_75eb818]\" id=\"form-field-field_75eb818\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_9771fde elementor-col-25\">\n\t\t\t\t\t<label for=\"form-field-field_9771fde\" class=\"elementor-field-label\">Country:<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_9771fde]\" id=\"form-field-field_9771fde\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_47ba854 elementor-col-25\">\n\t\t\t\t\t<label for=\"form-field-field_47ba854\" class=\"elementor-field-label\">Zip\/Postcode<\/label><input size=\"1\" type=\"text\" name=\"form_fields[field_47ba854]\" id=\"form-field-field_47ba854\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_4ced353 elementor-col-50\">\n\t\t\t\t\t<label for=\"form-field-field_4ced353\" class=\"elementor-field-label\">Email Address :  <\/label><input size=\"1\" type=\"email\" name=\"form_fields[field_4ced353]\" id=\"form-field-field_4ced353\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_31338c7 elementor-col-50\">\n\t\t\t\t\t<label for=\"form-field-field_31338c7\" class=\"elementor-field-label\">Email Address :  <\/label><input size=\"1\" type=\"email\" name=\"form_fields[field_31338c7]\" id=\"form-field-field_31338c7\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_59b4c3b elementor-col-50\">\n\t\t\t\t\t<label for=\"form-field-field_59b4c3b\" class=\"elementor-field-label\">Phone Number :<\/label><input size=\"1\" type=\"tel\" name=\"form_fields[field_59b4c3b]\" id=\"form-field-field_59b4c3b\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_b0ffc19 elementor-col-50\">\n\t\t\t\t\t<label for=\"form-field-field_b0ffc19\" class=\"elementor-field-label\">Phone Number :<\/label><input size=\"1\" type=\"tel\" name=\"form_fields[field_b0ffc19]\" id=\"form-field-field_b0ffc19\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_a67f19d elementor-col-100\">\n\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"DECLARATION\" data-previousbutton=\"Back\" data-nextbutton=\"Next\" data-iconurl=\"\" data-iconlibrary=\"fas fa-star\"><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_e29e801 elementor-col-100\">\n\t\t\t\t\tI confirm  that  all  the  information  given  on  this  application  form  is true and complete.\u00a0\u00a0I understand that any falsification or deliberate omissions may disqualify my application or lead to the termination of any future granted Distributor Agreement or Contract.\u00a0I understand that this form is merely a screening and is in no means a Distributor Agreement or Contract and that my application is subject to references that are satisfactory to Cube Atomizers.\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-field_677bae4 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup\"><span class=\"elementor-field-option\"><input type=\"checkbox\" name=\"form_fields[field_677bae4]\" id=\"form-field-field_677bae4\" class=\"elementor-field elementor-size-sm  elementor-acceptance-field\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_677bae4\">I confirm<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button type=\"submit\" class=\"elementor-button elementor-size-sm\">\n\t\t\t\t\t\t<span >\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-icon\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Submit Application<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<input type=\"hidden\" name=\"trp-form-language\" value=\"ro\"\/><\/form>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Distributor Application Online Form<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":[],"_links":{"self":[{"href":"https:\/\/www.cubeatomizers.com\/ro\/wp-json\/wp\/v2\/pages\/5818"}],"collection":[{"href":"https:\/\/www.cubeatomizers.com\/ro\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.cubeatomizers.com\/ro\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.cubeatomizers.com\/ro\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.cubeatomizers.com\/ro\/wp-json\/wp\/v2\/comments?post=5818"}],"version-history":[{"count":10,"href":"https:\/\/www.cubeatomizers.com\/ro\/wp-json\/wp\/v2\/pages\/5818\/revisions"}],"predecessor-version":[{"id":5847,"href":"https:\/\/www.cubeatomizers.com\/ro\/wp-json\/wp\/v2\/pages\/5818\/revisions\/5847"}],"wp:attachment":[{"href":"https:\/\/www.cubeatomizers.com\/ro\/wp-json\/wp\/v2\/media?parent=5818"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}