Dealer Registration Form

Please provide all required details below to qualify your business with us. If your company qualifies to become a dealer, a U.S. Enzyme representative will be in contact with you to discuss further opportunities. Thank you for your interest.

Business Owner*

First NameLast Name

Business Name*

Contact Number*

Area CodePhone Number

E-mail*

Company Website*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Type of Business*

How long have you been in business?*

Please list the products that you service/sell.*

Please provide a short description about your company.*

How did you hear about U.S. Enzyme?*

If Other was selected above, please specify here:*

Please describe your current interest level in becoming a Matrix Basement Dealer.*

Looking to start selling in in the next 3 monthsLooking to start in 6 monthsLooking to start in 12 monthsCurrently just researching for dealer opportunitiesReady today

What market do you service? What is your geographic reach?*

What is your annual sales volume?*

How many sales people do you have on your team?*

What is your monthly marketing budget and what marketing mediums do you utilize?*

What experiences, if any, do you have in mold remediation?*

Dealer pricing requires pre approval application, Protocol training, initial 55 gallon purchase and quarterly minimum purchase commitment of 55 gallons. If one quarter is missed then wholesale pricing will automatically apply.

All online purchases are paid at the time of order. Preapproval is needed to be invoiced and are to be paid 30 days from the date of the invoice.

Claims arising from invoices must be made within seven working days.

By submitting this application, you authorize U.S. Enzyme to make inquiries into the banking and business/trade references that you have supplied.

Date Signed

Date

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PERSONAL GUARANTEE

By signing this credit application/agreement are executing this application on behalf of Buyer and personally guarantees, and agrees to be personally liable for the failure of the performance by Buyer of, any and all of Buyers; obligations under this application with U.S. Enzyme, including timely payment of any and all sums due to U.S. Enzyme. As Guarantor you are personally guaranteeing the prompt, full and complete performance of any and all present and future duties, obligations and indebtedness (the “Debt”) due to the Lender by the Debtor The personal guarantee also applies in the event that they Buyer declares Bankruptcy or applies for Bankruptcy protection.

By submitting this application, you authorize U.S. Enzyme to make inquiries into the banking and business/trade references that you have supplied.

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