ClearWater Tech

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