How Can We Help?
Select an Option
*
Please Select
Current Distributor – Question About An Existing Purchase Order (P.O.)
Current Distributor – Sales Inquiry
General Inquiry
Product Comment, Question, or Complaint
Request To Become A Tillman Distributor
Where To Purchase Tillman Products
Name
*
First Name
Last Name
Company
*
Job Title
*
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Current Distributor – Question About An Existing Purchase Order (P.O.)
What is/are your purchase order number(s) and date(s)?
Purchase Order 1
Purchase Order 2
Purchase Order 3
Enter PO Number On This Line
Enter PO Date On This Line
Do you have additional POs that you need assistance with?
NO
YES
What is/are your purchase order number(s) and date(s)?
Purchase Order 4
Purchase Order 5
Purchase Order 6
Enter PO Number On This Line
Enter PO Date On This Line
Do you have additional POs that you need assistance with?
NO
YES
What is/are your purchase order number(s) and date(s)?
Purchase Order 7
Purchase Order 8
Purchase Order 9
Enter PO Number On This Line
Enter PO Date On This Line
Please leave any additional comments here:
Current Distributor – Sales Inquiry
Are you interested in: (Check all that apply)
Obtaining Samples
Product Pricing
Contacting a Tillman Rep
I have a potential opportunity for Tillman
Please leave any additional comments here:
General Inquiry
Please leave your message here:
Product Comment, Question, or Complaint
Model/Part Number for Product in Question
Date Purchased
-
Month
-
Day
Year
Date
Product Purchased From
Upload Photo(s) of Product
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please leave your comment, question or concern here:
Request To Become A Tillman Distributor
Do you currently sell Personal Protective Equipment (PPE)?
YES
NO
What welding protection products brands do you currently sell?
What glove brands do you currently sell?
Please leave your message here:
No need to fill out this form. Click here to be taken to the Tillman Distributor Locator.
Submit
Should be Empty: