| 经销商姓名 | 数量 | 地址 | |
| 1 | ____________ | ____________ | ____________ |
| 2 | ____________ | ____________ | ____________ |
| 3 | ____________ | ____________ | ____________ |
| 4 | ____________ | ____________ | ____________ |
| 5 | ____________ | ____________ | ____________ |
| 6 | ____________ | ____________ | ____________ |