B&B Client Request Form

B&B Client Request Form
Company Name*

Company NameCompany Representative
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Website*
Phone Number*
Please enter a valid phone number.
Purchase Requirement

New chemical initial purchase requirement is $5,000.
Do you have a current state business license?*

YesNo
Do you have a Federal EIN?*

YesNo
Do you have a resale license?*

YesNo
How many years have you been in business?*
Are you currently purchasing chemical from another vendor?*

YesNo
Does your business currently sell hazardous materials?*

YesNo
Have you requested a quote from B&B Blending before?*

YesNo
What best describes your business need?*

Car CareMarine CareContruction/Heavy DutyHome Care & CleaningIndustrial Care & CleaningOther
What type of products are you interested in?*

Ceramic Coatings/Graphene Ceramic CoatingsBug & Tar RemoversCompounds/Polishes (*Minimum purchase quantities required)DegreasersDetail SpraysInterior CleanersLeather and Fabric CareMetal PolishesTire and Wheel CleanersTunnel Wash and Self-Service Car WashVinyl & Tire DressingsWaxesWindow CleanersFloor CleanersOther
If "other", what product type are you interested in?*
Do you need your own brand on your product?*

YesNo
What estimated initial quantity of product are you interested in?*

Less than 110 Gallons110 Gallons330 Gallons440 Gallons880 GallonsMore than 1000 Gallons
Are you in need of custom packaging?*

YesNoI have my own
If you have your own packaging, please describe:
Do you have labels?*

YesNo - If "no" you will need to source your own graphic designer to assist you in label creation.
Additional comments:
Should be Empty:

B&B Client Request Form

Purchase Requirement