International UV Distributors Application

Company Name:  

Company Size /number of people/:  

Annual Sales in USD:   

Company Main Business Focus:   

President or CEO Name:*  

Contact Name:*  

Mailing Address:*  

City:*  

State:*  

Zip code:*  

   Shipping Address /if different/:  

City:  

State:  

Zip code:  

Forwarding /shipping/ Agent in the USA:   

E-Mail:*  

Phone:* 

Fax:  

Website:   

Have you done business with US companies:   

UV Products of interest:   

How do you plan to market the UV products:   

How did you learn about American Air & Water?:  

Choose one Internet Direct mail Newspapers TV Radio A friend