RESELLER APPLICATION
 
Reseller Application

All items with a green asterisks (*) are required.

Company Information
*Company Name :
*DBA :
*Contact Name :
Title:
*Phone:
Fax:
*E-mail:
*Company Address:
*City
*State:
*Zip:
Yr. Established:
Annual Sales:
Employee Count:
Type of Business:
 Sole Prop. Partnership Corporation
Other:
 
Business Profile
Retail Location:
 No Yes | If yes, number of stores:
Primary Business:
Plumbing HVAC Other:
Industry Focus:

Homebuilders Government Utilities Retailers
Sector Focus:
 Residential Commercial Industrial
Lic Plumber:

Yes No Future
Market Focus:
Local Regional Other
Do you represent other mfg:
 No Yes | If yes, please list:
CC Accepted:
 Visa/Mastercard American Express None
 
Business/Trade References
Company Name:
Address:
City
State:
Zip:
Phone:
Fax:
E-mail:
Relationship:
Company Name:
Address:
City
State:
Zip:
Phone:
Fax:
E-mail:
Relationship:
 
Additional Information
Can you carry inventory? Yes No
Can you provide installation support? Yes No
How did you hear about us? Web Call Tradeshow Other:
 
Agreement
1. By Submitting this application, you authorize AirGenerate, LLC to verify the information supplied above.
2. You understand that this is just an application and AirGenerate, LLC reserves the right to reject or approve any application.

Agree Disagree