

		Call Toll Free: (800) 775-9474International: (772) 335-8225

Enviroseal Distributor Application

DISTRIBUTOR INFORMATION AND APPLICATION

ENVIROSEAL is a very unique Company. We are driven by both sales goals and Chemical and Civil Engineering expertise. We know the soils and we know the machinery it takes to accomplish the job. Combined we have over 100 years of hands on experience.

The type of organization we at ENVIROSEAL require for us to consider your application is as follows:

You must be either a successful highway construction company or civil engineering company.
You must have an open mind to a new technology and be willing to use your new knowledge.
You must have a successful record of completing Government Road Contracts.
You must be willing to spend time marketing our products, including hiring at least one full time sales civil engineer.
You must provide a financial profile on your Company, your bank and verifiable references. We need strong Companies.
You will have a Distributor Contract covering an entire Region, State, or Country depending on the population density. Most Distributors outside the U.S.A. are restricted to one country. In certain circumstances if the country is large (i.e.) Russia, India, or China, we may agree to split up the distributorship territory or have the distributor sub-territories.
You will receive Factory assistance from your first installation forward. If for any reason the job we install fails, we will gladly refund costs on any construction job we supervise for the Distributor.
Initial installation will only to be done with our technicians present. There is a minimum product order.

So send us your information And we will send you a complete set of laboratory instructions along with one 500 ml bottle for each of our products. Contact us via fax (772) 335-3991, Phone: (772) 335-2824 or e-mail sales@enviroseal.com

ENVIROSEAL DISTRIBUTOR APPLICATION

All Application Fields are required enties.
Name
E-Mail
Company Name
Address
City
State
Zip Code
Phone
Fax
Country

Type of Business	Corporation \| Partnership \| Sole Propietor
Partner or Corporate Officers
1. Name
Title
Address
Phone
2. Name	if none type "none"
Title	if none type "none"
Address	if none type "none"
Phone	if none type "none"
Trade References
1. Name
Company
Address
Phone
2. Name
Company
Address
Phone
Bank References
Name
Title
Address
Phone
List Gross Sales Last Three years:
	2005 2006 2007
Can you provide current Corporate Statements?
	Yes No
If so, What Years can you provide?

Is your Company currently profitable?

List your current construction experience:

Do you have Civil Engineers in House?
	Yes No
Do you presently have a Sales Organization?
	Yes No
If so, how many Sales Representative do you have employed?