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Online Application for Distribution

Company Name *
Address *
City St Zip *
Phone *
Fax
Purchasing Agent *
Sales Manager
"Ship to" Address
City St Zip
Email Address *
Website Address
Type of Business
Number of Employees
Number of Salespeople
Annual Sales
Sell Retail Yes No
Do you have a minimum retail order requirement? If so, amount $
What markets for plastic polish
do you serve?
How do you reach your customers?
(e.g., Catalog Sales, Telemarketing, Direct Sales, etc.)
Catalog Circulation
Do you currently sell a Plastic Cleaner, Scratch Remover, or Polishing Cloth? If so, please list the product name and manufacturer
How did you first hear about
NOVUS Plastic Polish?
*