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Distribution Application

Please fill out and submit this form if you are interested in pursuing business relations with United-Tech, Inc. Alternately, you can download the PDF version and submit by FAX to (918) 610-5225.

NOTE: Please complete all applicable information. Required fields are marked with *

1.

Company Name:

2.

Contact Name:

*

3.

Address:

*

City:

*

State/Province:

*

 

Country:

*

Zip/Post Code:

*

4.

Contact Information:

Phone

*

Fax

Email

 *

Web Site URL (if any)

5.

What are your primary fields of sales activity?

Hold down Ctrl Key to select
multiple choices.



If Other, explain:

6.

Form of Organization:

Sole Proprietorship
Partnership
Corporation/Limited Company

7.

Please list the types of products you manufacture, if any:

8.

Please list product lines and names of other companies you represent, including City/Country name and annual sales volume in US Dollars:

Product Line / Company

City & Country

Annual Sales Volume

Additional Product Lines:

9.

Total Number of Employees:

*

    # of Salespeople:

    Service/Staff/Technicians:

    Engineers:

    Ph.D.s:

    M.Sc.s:

    B.Sc.S:

    Specialists in-

  

        Wastewater Treatment:

        Aquaculture:

        Water Gardening:

        Water Body Restoration:

        Bioremediation:

        Other:

10.

Approximate company annual sales volume for past year (in US Dollars):

*

11.

Geographic sales territory:

*

12.

Sales forecast of UTI products during first twelve (12) months (US $ or units):

*

13.

Trade/Business References:

*

      Company Name

City/Country

Phone/Fax #s

     

     

     

14.

Does your company participate in trade shows?:

*

If Yes, which shows?

15.

How many people, of your staff, would you be willing to have available for training?

*

Distribution Application completed by:

 

Name:

*

Title:

*

Date:

*

Please note: We do not share your information with third parties. Read our Privacy Policy here.

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