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One Hanover Street
Gettysburg, PA 17325

(717) 337-9325 [p]
(717) 334-0224  [f]

E-Mail Us
Interested in becoming an Aquatron Distributor?

There are 2 easy ways to begin the process:

1. Complete the form below and click "Continue" at the bottom of the application.

OR

2. Click HERE to download the PDF version to print and fax or mail to our office
Choosing to sell the Aquatron may be one of the best decisions you have ever made.

Backed with our unconditional guarantee, Aquatron's superb performance and immediate results for your customers facilitate quick and confident sales.
Regardless of your industry, residential, commercial or agricultural, Aquatron can help you to help your customers have cleaner, healthier and higher quality water.
Please Note:
Documents must be fully complete before an account is opened and pricing quoted. We do not want to delay your application.
ACCOUNT HISTORY (* Required)
Have you had an account with Nathan Jefferson Enterprises, Inc. or Aquatron before? If yes, under what account Yes No
If yes, under what account name/number?
DESCRIPTION OF YOUR BUSINESS
Date your business was established? (mm/dd/yyyy)
Length of time at this address: years months
Field of interest and expertise
What industry(ie) do you currently operate in?

How many units are you willing to maintain in your inventory?
Intended method of sales and promotion
This company is a (select one) Sole Proprietorship
Partnership
Corporation in (state)
Type of Corporation (S) (C) (LLC)
Is there a parent corporation or subsidiary? Yes No
If yes, who?
Legal Business Name (As it appears on your business license)
Business Trade Name (DBA)
Business Web Site Address
CONTACT INFORMATION (* Required)
Address
City
County
State Zip Code
Business Phone
Business Fax
Primary Contact (* Required)
Officers' / Owner's Name
Title
E-Mail Address
Secondary Contact
Officers' / Owner's Name
Title
E-Mail Address
Additional Authorized Purchaser(s)

 
 

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