Yes, I’m Interested in Becoming an
Air Intake Filter Technology Reseller.

Air Solution Company Markets Air Intake Filter Products through a network of Air Filter Distributors, OEM’s, Water
Treatment Companies and Cooling Tower Service Companies. Because we value our reseller business relationships
and recognize the importance of not over saturating any region, we carefully manage our distribution channels to protect
our resellers against channel conflict while ensuring end customers have access to reputable resellers in their region.

To Inquire About Becoming a Distributor Please Contact:

Randy Simmons
Air Solution Company
800-819-2869 ext.801 or 513-860-9784

Distributor / Reseller Application and Credit Reference Form
Click Here For PDF Version

Secure Authorized Distributor and Credit Application

Please fill out all fields below

Authorized Distributer/Credit Application

Are You Applying To Become A Distributer Or Applying For Credit? Are You Applying To Become A Distributer Or Applying For Credit? Distributer Credit Only

Business Name

Website Address

Management Email Address

Telephone

Address (street/city/ state/ Zip)

Fax

Mailing Address If Different From Above

Annual Sales Volume

Number of Sales Representatives

In Business Since

Type of Organization Type of Organization Sole Proprietorship Partnership Corporation

Subsidiary of

Primary Business (check all that apply) Primary Business (check all that apply) Distributor - Air Filtration Product Air Filtration Maintenance & Service Water Treatment Services Liquid Filtration Maintenance & Service Cooling Tower & HVAC Sales Cooling Tower & HVAC Maintenance & Service Other

Specify Other

Do You Manufacture Any Filtration Products? Do You Manufacture Any Filtration Products? Yes No

Please Describe Your Products

Principle Owner/Officer

Telephone/Email

Sales/Marketing Officer

Telephone/Email

Sales Manager

Telephone/Email

Accounting / Accounts Payable Contact

Accounting Telephone Number

Accounting Email (required)

Trade References 1

City & State Location

Contact Name

Telephone

Email (required)

Trade References 2

City & State Location

Contact Name

Telephone

Email (required)

Trade References 3

City & State Location

Contact Name

Telephone

Email (required)

Trade References 4

City & State Location

Contact Name

Telephone

Email (required)

Trade References 5

City & State Location

Contact Name

Telephone

Email (required)

Bank Name

Account_Number (Call Into Credit Dept If Preferred)

Bank Address

Bank Telephone

Are Products Purchased For Resale? Are Products Purchased For Resale? Yes No

Resale Certificate #

What Regions or States Do You Actively Sell In?

Sales Team Contact Information (Rep Name, Office Address, Phone Number, Email) one per line

Terms and Conditions Terms and Conditions I have read and agree to the Terms and Conditions