Customer Application/Registration Form

Distributor Application Form

We are pleased that your company is interested in becoming our Distributor in your area. Oromask very closely with our distributors to assure that we will always have satisfied customers.

In order to provide our customers with the best application support for selection of a cost effective solution (supporting both their technical and financial requirements) and later ensure continuous post sales support requires us having the best distributors.

    Your Full Name
    Your Email
    Phone Number
    Web Address
    Trade Business Name (DBA)
    Business Legal Name
    Type of Business
    Branch Locations
    Estimated Annual Sales
    Primary Sales Territory
    Business Address