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Dealer Application Form

If you are interested in buying Go Green products for resale and become a Go Green distributor. Please fill out the following fields,please fill out ALL FIELDS as we cannot process your request without these informations. Thank you for inquiring about Go Green!

 

indicates required field

Wholesaler / Dealer Company Profile:
COMPANY NAME:
STREET ADDRESS:
CITY:
STATE:
ZIP:
COUNTRY:
PHONE NUMBER:
FAX NUMBER:
PRIMARY CONTACT PERSON:
TITLE:
EMAIL ADDRESS:*
which product are you interest to distribute:* Superior Cold Mix Asphalt
Micro Paving Cold Mix Asphalt
Cold Mix Color Asphalt
Warm Mix Color Asphalt Emulsion
Colorless Asphalt Binder
Color Asphalt Pigment
Pourable Crack Filler
Crack Tape
Asphalt Recycling Agent
High-viscosity asphalt
Geogrid & Geotextile
Others
TYPE OF BUSINESS: Manufacturing      Dealer     Integrator     Corporation     Partnership      Sole Proprietorship
HOW MANY YEARS HAS THE COMPANY BEEN IN BUSINESS?
YEARS AT PRESENT LOCATION?
ANNUAL REVENUE
WHAT TYPE OF BUSINESS ARE YOU IN (enter percent if more than one):
 Road Contractor %  Road Materials %
 Municipal Road Project %  Bitumen %
 Equipment %  Landscaping %
 Civil Engineering %  Other Industrial %
YOU ARE PURCHASING FOR: RESALE     USE IN YOUR BUSINESS
KEY PERSONNEL:
NAME TITLE
YOUR WEBSITE ADDRESS:
DO YOU HAVE A CATALOG? YES     NO        If Yes, Frequency? 
HOW MANY SKU's DO YOU SELL?
DO YOU CURRENTLY CARRY GO GREEN® PRODUCTS? YES     NO
If so, where do you purchase them? (Please list all sources)
HOW DID YOU FIND OUT ABOUT GO GREEN® ? (Please choose an option)
Website/Search Engine (Google, Bing, Ask, Etc.)
Word of mouth ( heard from a customer, friend, colleague, supplier etc.)
Social Network ( Linkedin, Facebook, Google+, Twitters, WeChat, etc.)
Email/ Newsletter   
Advetisement (Google, Alibaba, B2B,etc.)
I saw it on a poster/flyer/brochure
Youtube Magazine/ Newspaper
Exhibition Industry Association
Other ( please specify ):
DO YOU HAVE ADDITIONAL OFFICE LOCATIONS? YES     NO
If Yes, Please List: PRIMARY CONTACT, ADDRESS, PHONE, & FAX for each:
DO YOU HAVE WAREHOUSE FACILITIES? YES     NO
If Yes, Please Describe (please include square footage):
DO YOU HANDLE PRODUCTS THAT ARE COMPETITIVE WITH GO GREEN® PRODUCTS? YES     NO
If Yes, Please Explain:
ARE YOU PART OF A BUYING GROUP / AFFILIATION / COOP? YES     NO
If Yes, Please List:
DO YOU MANUFACTURE PRODUCTS? YES     NO
If Yes, Please Describe:
LIST THE COMPANIES / MANUFACTURERS THAT REPRESENT THE MAJORITY OF YOUR SALES VOLUME.
Please indlude: COMPANY NAME, PRODUCT(s), & IF YOU CARRY STOCK
WHICH COMPANY REPRESENTS THE LARGEST PERCENTAGE OF YOUR SALES VOLUME?
INFORMATION FOR THIS FORM WAS AUTHORIZED BY:
NAME:*
TITLE:*
EMAIL:*
DATE:*
 
    
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