Fax To: 661-250-7373
ATTN: Ben Weinberg
3D International, L.L.C.

Distributor & Jobber Inquiry

Please fill out the following information out so that we may send you pricing and information.

Company: ____________________ Phone: _______________________
Contact: ______________________ Fax: _________________________
E-Mail: ______________________ Web Page: ____________________

Address: _______________________________________________________
_______________________________________________________________
_______________________________________________________________

Do you own or work for any Company in the car care industry? Yes No
If yes, which Company? ___________________________________________ _______________________________________________________________

Do you currently sell car care products? Yes No
If yes, which brand? _______________________________________________ ________________________________________________________________

Are you currently happy with your current supplier and if not, why? _________
________________________________________________________________

How much do you currently buy per month in car care products? ____________
How much do you plan to sell per month in car care products? ______________

Anything else that you would like to tell us? _____________________________
_________________________________________________________________
_________________________________________________________________

Once we receive your application, we will consider you for distributor and jobber pricing.

You should get a response back within 2-5 days. If you do not hear back from us within a week after submitting your inquiry, please call us at 661-250-2020. Please fax this form to 661-250-7373