Thermidaire water treatment chemicals Distribution form

Distribution Request Form

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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

Category

First Name

Last Name

Position

E-mail

Street Address

City

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

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... Product support team at Thermidaire ...

Please complete the following Request.

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

How to contact you...?

Please select one... By E-Mail. By Phone. By Fax. By Mail.

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