B&B Client Request Form
Company Authorized Representative
*
First Name
Last Name
Company Name
*
Please enter your business name above
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Company Website
*
Please enter your business website above.
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Purchase Requirement
New chemical initial purchase requirement is $5,000+.
Do you have a current state business license?
*
Yes
No
Do you have a Federal EIN?
*
Yes
No
Do you have a resale license?
*
Yes
No
How many years have you been in business?
*
Are you currently purchasing chemical from another vendor?
*
Yes
No
Does your business currently sell hazardous materials?
*
Yes
No
Have you requested a quote from B&B Blending before?
*
Yes
No
What best describes your business need?
*
Car Care
Marine Care
Contruction/Heavy Duty
Home Care & Cleaning
Industrial Care & Cleaning
Other
What type of products are you interested in?
*
Ceramic Coatings/Graphene Ceramic Coatings
Bug & Tar Removers
Compounds/Polishes (*Minimum purchase quantities required)
Degreasers
Detail Sprays
Interior Cleaners
Leather and Fabric Care
Metal Polishes
Tire and Wheel Cleaners
Tunnel Wash and Self-Service Car Wash
Vinyl & Tire Dressings
Waxes
Window Cleaners
Floor Cleaners
Other
If "other", what product type are you interested in?
*
Do you need your own brand on your product?
*
Yes
No
What estimated initial quantity of product are you interested in?
*
Less than 110 Gallons
110 Gallons
330 Gallons
440 Gallons
880 Gallons
More than 1000 Gallons
Are you in need of custom packaging?
*
Yes
No
I have my own
If you have your own packaging, please describe:
Do you have labels?
*
Yes
No - If "no" you will need to source your own graphic designer to assist you in label creation.
Additional comments:
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