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  Distribution Request Form    

... Product support team at Thermidaire ...

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Thermidaire Location

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Please complete the following Request.

 Do you want to be Distributor or Agent?

 Thermidaire is looking for qualified chemical distributors and agents world wide to represent our product line. 

If you are a chemical distributor or an individual agent interested in expanding your existing line of products, 

please complete the form below in details.

Company Name


First Name

Last Name



Street Address


State / Province

Zip/Postal Code

                                                                       Country                                                       Other, please specify.

                                                                     Telephone                                                                     Fax


                                                                Which group of products are you interested in...?


                                                                How to contact you...?


Comments/please detail your current territory/market/ industry chemical activity 

and areas of interest with Thermidaire

How did you learn about Thermidaire ?


Thank you for taking the time to fill this form

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 Thank you for taking the time to contact Product Support Team at Thermidaire!

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