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Etowah Chemical Sales & Service Distributor Application Form

Distribution opportunities are available in some areas. If you are interested in joining our team fill out the following information about yourself and your company, then submit it to us online!

Company Information

 

Company Name

Your Name

Mailing Address

City

State

Zip Code


Shipping Address

City

State

Zip Code


Phone Number

Fax Number

Your E-mail Address


Business Type is

Number of Salesmen

Equipment Brands Distributed

Presently Purchasing Chemicals From

Do you want Private Label?

Do you mix any of your own chemicals?

Your Geographic Area of Coverage by County or Parish


I would like help in: (choose all that apply)

Sales Training Product Knowledge Regulatory Issues Waste Management


Your Facility Information

Do you use a computer in your operation?

Do you have a tractor-trailer freight dock?

Can you be served by a 53' trailer? If not, how long?

Do you have a fork lift?

Do you have pallet racks?

Would you be willing to attend training in Gadsden, AL?

What could Etowah Chemical do to make your distributorship more profitable?

 

 

 

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