Distributor Application

Email

Business Name

Name

Phone Number

Billing Address

Shipping Address

How long have you been in business?

Who is your PRIMARY customer base?

Select One
Animal Care
Artificial Turf
Food & Beverage (including restaurants, factories, and breweries)
Janitorial Departments
Medical Care Providers (hospitals, doctors, dentists, etc.)
Pool & Spa
Other

Who are your secondary customer bases? (Select all that apply or leave empty if not applicable)

Animal Care Artificial Turf Food & Beverage (including restaurants, factories, and breweries) Janitorial Departments Medical Care Providers (hospitals, doctors, dentists, etc) Pool & Spa School

What product lines are you interested in selling?

Wysiwash ScaleSafe

How do you primarily sell your current products?

In-Store Online via my own ecommerce site Online via Amazon, Walmart, Ebay, or other online marketplace Other

If you selected other, please explain how you primarily sell your products.

Where do you currently store the products that you sell? (Please keep in mind that all our products must be kept in a temperature controlled environment and CAN NOT be stored outdoors or in garages)

Warehouse Office space In a retail store (or storage attached to a retail store) At my home Other

If you selected other, please explain where you currently store the products that you sell.

Is there anything else you'd like to share about your business that you think is relevant to your application?