Retailer/Dealer/Professional Sign-Up
Supplying E-Z Patch products in your retail store or using them in your business as a Pool Professional:, is the best way to let your customers/clients know you care about results!

Many of our current customers have built their reputation for quality around our products.

Go ahead and complete the first step below. We'll get back to you promptly with the the additional information needed to set up your Professional or Dealer account.

Name:

Company:

Phone:

Fax:

E-Mail:

Address:

City:

State/Zip:
  
Info 1:

Info 2:


Which answer best describes your business:
Dealer/Distributor
Single Unit Retailer
Multi Unit Retailer
Pool Professional

How long have you been operating:
Start-up
1-3 years
3-7 years
Seems like forever

Products of interest. (Multiple Selections OK):
Swimming Pool Cement Repair Supplies & Coatings
Swimming Pool Flexible Repair Supplies & Sealants
Ceramic Tile Repair Supplies

How Did You Hear About Us:


Please include a brief "Business Description" including business license # if available: (see hints below)


Optional description, request or comments:





HINTS:

Some form of Business ID is required for discount purchases. In lieu of a state license you may elect to fax a copy of your  Federal W-9 form as a follow-up.

Instructions for this procedure (if needed) will be emailed to the address you enter above.


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