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Become a dealer - Dealer Registration Form

Become a Aqua Shield Inc. SunroomScreen™ Dealer

Complete and submit the following form if you are interested in pursuing a SunroomScreen™ distribution opportunity. This could be an added product line to your existing business or a full-time opportunity for a totally new and very profitable addition to your revenue stream.

Please make sure you fill out all required fields (highlighted in blue).
Login Information
Verify Password:
Contact Information
First Name:
Last Name:
Address 1:
Address 2:
Zip Code:
Verify Telephone:
Telephone Extension:
Verify E-mail:
Website Address:
How did you find out about
Company Information
Company Owner/President:
Name of Person Completing this Application:
(If other than Owner/President)
Your Title:
Showroom Address
if different from above:
Address 1:
Address 2:
Showroom City:
Zip Code:
Showroom Sq. Footage:
Warehouse Sq. Footage:
Business Entity is a: Corporation
Sole Proprietor
Years in Business:
Years at Present Location:
Contractor License #:
Year Issued:
Are your orders (if in NY): All Taxable
All Exempt
Sales Tax ID:
Do you have a sales force? Yes No
If "Yes" number of Sales People:
Describe your Company's Business Practice:
Product lines currently carried:
Percentage of existing business: % Commercial:
  % Residential:
Business Plan
I am interested in becoming one of the following:
Do you currently sell enclosures
(screen, patio rooms, etc.)?
Yes No
If "Yes" what brand?
Primary reason for wanting to change or add our product line:
Do you have your own installation crews? Yes No
If "Yes" how many years have they been installing?
How soon would you like to begin actively marketing and selling our enclosures?
How will sales leads be generated? (Check all that apply)
Newspaper Home Shows
Mall Shows Television
Radio Magazines
Direct Mail Yellow Pages
How many units do you project selling?
List the territory you would like to service:
(include City, County and Population)
Additional Comments:

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