ClearWater Tech

Ozone Water & Air Treatment Solutions


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800.262.0203 | 805.549.9724 | sales@cwtozone.com

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Customer Prospect Form

    Company Name

    Main Phone

    Website

    Tax Resale Number

    Address

    Address 1

    Address 2

    City

    State

    ZIP

    Country

    Billing Address (If different from above.)

    Address 1

    Address 2

    City

    State

    ZIP / Postal Code

    Country

    Shipping Address (If different from above.)

    Address 1

    Address 2

    City

    State

    ZIP / Postal Code

    Country

    Your Contact Information

    Name

    Title

    Phone

    Email

    Questionnaire (All questions must be answered.)

    What is the nature of your business?

    What is you geographical territory?

    What is the potential ozone market size (Dollars)?

    Does your company sell through a network of dealers or direct to end-user?

    Does your company provide engineering assistance?

    YesNo

    Does your company provide installation?

    YesNo

    Does your company provide service?

    YesNo

    How long has your company been in business?

    Key Personnel

    This information will help CWT to better serve your company.

    Owner/Proprietor/Partner/Officer

    Name

    Title

    Phone

    Email

    Purchasing (This person would receive 'order acknowledgements', 'order shipped notifications' and 'shipment tracking numbers'.)

    Name

    Title

    Phone

    Email

    Accounting / AP (This person would receive invoices from us.)

    Name

    Title

    Phone

    Email

    Sales

    Name

    Title

    Phone

    Email

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