Omni-ajax Inc. - Spill Control Products

49 Pocono Forest ° Gouldsboro, PA 18424 - Phone: (570) 848-4186 - FAX: (570) 421-8052

Application to Become a Distributor

Complete this application to initiate the process to become a distributor.
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Registered Company Name:
Trading Name:
Contact Information:
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Postal Address:
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Manager Email:
Website:
Business Information:
Business Type:	Corporation, LLC, Partnership, Sole Propritership, Other
Years in Business:		ABN:
Business Hours:		Number of Employees:
Is your company a distributor for other Spill Control Products? Which Products?

What markets does your business target?

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2. Company:		Contact Name:
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