Distributor/Reseller Application

General Information

Company Name:
E-mail address:
Address:
Telephone Number:
Contact: (Name & title)
Territory Desired:
Type of Distributorship Wanted: Non-Exclusive (No deposit, may also sell competing brands. May graduate to exclusive by selling $50,000 worth of product in one line in one year) Exclusive (Deposit required - determined by extent of product line and size of country, usable against product purchases within one year. May not sell competing brands. )

Company Organization Sole Proprietorship Partnership Corporation Other - Explain:

If your company is a subsidiary of another company, please give information on the parent company here: Name of Parent Company: Address of Parent Company:

Branch Offices:  1) Branch Name: Address: Phone: E-mail:	2) Branch Name: Address: Phone: E-mail:
3) Branch Name: Address: Phone: E-mail:	4) Branch Name: Address: Phone: E-mail:

Principal Officers/Owners:  1) Name Title Home Address Home Phone Personal E-mail:	2) Name Title Home Address Home Phone Personal E-mail:
3) Name: Title Home Address Home Phone Personal E-mail:	4) Name Title Home Address Home Phone Personal E-mail:

Sales Manager's Name:

Service Manager's Name:

Do you have a well-equipped laboratory to perform bench tests? Yes No For microbial products, demulsifiers and polymers, we require distributors to be able to perform bench scale tests, to determine or confirm product selection (all three lines) and dosage (polymers and demulsifiers). A lab can be fairly rudimentary and still be acceptable for this purpose. Distributors of fuel additives and chemical water treatment are exempt from this requirement.

If you do NOT have a lab, do you have access to an independent lab? Yes No Distributors must be able to provide technical service to accompany the sale of our products. This includes the ability to perform (or hire another lab to perform) standard laboratory analysis tests, to help us prescribe appropriate treatment for clients (specific tests needed are listed on our system diagnostic forms).

Does your company participate in trade shows? Yes No If yes, which ones do you attend annually, and what market do they address?

Please tell us why you think your company would be especially suitable to represent Alken-Murray Corporation If you have a company website, please give the address here

Marketing Information

Product Lines WANTED from Alken-Murray

Select which of our product lines you would like to represent: Fuel Additives/Treatment Demulsifier Polymers Chemical water treatment for cooling towers & boilers Microbial and Related Products Odor Control Lake/Pond/Aquaculture water remediation Industrial/Municipal microbial water and waste treatment products Bioremediation Grease and fats biological degradation for drains/septic Other Specify: If you currently represent competing products, do you wish to substitute our products? Yes or offer them in addition to your current product lines?

Competing Products You Currently Represent

Check any of the following lines that YOU CURRENTLY represent or distribute: Industrial water treatment : For Boilers What brand do you sell (name of manufact.)? For Cooling Towers What brand do you sell (name of manufact.)? Other chemicalsWhat brand do you sell (name of manufact.)? If chemicals, describe application:   Fuel Treatments/Additives: For Boilers What brand do you currently sell (name of manufact.)? For Marine vessels What brand do you currently sell (name of manufact.)? For Bunkering What brand do you currently sell (name of manufact.)? For fireside/coal What brand do you currently sell (name of manufact.)? For Trucks, Heavy equipment What brand do you currently sell (name of manufact.)? Demulsifiers What brand do you currently sell (name of manufact.)? Polymers What brand do you currently sell (name of manufact.)?   Microbial Products: Hydrocarbon/petroleum remediation products What brand do you currently sell (name of manufact.)? Municipal/industrial waste treatment products What brand do you currently sell (name of manufact.)? Aquaculture water improvement products What brand do you currently sell (name of manufact.)? Lake, Pond, River restoration products What brand do you currently sell (name of manufact.)? Household Use/Retail Products What brand do you currently sell (name of manufact.)? Odor control in landfills/subways/junk yards/meat packing plants, etc. What brand do you currently sell (name of manufact.)? Drain lines/collection and septic system treatments What brand do you currently sell (name of manufact.)? Anaerobic digester treatments What brand do you currently sell (name of manufact.)?

Is there anything else that you would like to tell us about your company? If an official Alken-Muray distributor is caught utilizing SPAM to market Alken-Murray products under our brand names (Alken, Clear-Flo, Even-Flo,Enz-Odor, Treat-A-Loo, Bio-Nutrient, Alken Solutions, Alken Treatment) , they will be immediately removed from our distributor index and their right to purchase products from us will be cancelled.

t