Dealer Inquiry Form

Contact Information:

Name:
Company
Address
Address
City:
State:
Zip:
Country:
Telephone:
Fax:
e-mail:
website:

Business Description:




Year business was founded:

Business structure: Sole Proprietor Partnership Inc Corporation

Annual sales volume: Under $500,000 $500,000-$1 million Over $1 million

Anticipated monthly volume with Stargate:

Your company functions as: Rep Firm Distributor Dealer Wholesaler Other (describe)



Which of the following types of Commercial/Industrial equipment do you currently sell?
Check all that apply

Water Softeners	Backwashing Water Filters	Ozone Systems	Pumps
UV Sterilizers	DI Systems/Exchange Tanks	Reverse Osmosis	Wastewater Treatment Systems

Please list at least three manufacturers of water or wastewater treatment equipment you currently represent:




List any degrees or certifications held by employees of the company:




Comments:

 

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