Distributor Application

Interested in becoming a distributor? Simply fill out the form below so that we may evaluate your potential distributor under the RejuvaSeal USA Distributor Network. Please allow us 24-48 hours to respond to your request.

Your Name
Company Name
Address
Phone
Email Address
Web Address
What counties do you service?
Number of years in business?
Services Offered
Annual Sales Revenue
Maintenance business as a % of sales
Does your company own a paver?
- Yes
- No
Have you seal coated any large facilities?
- Yes
- No
Largest seal coat contract (Sq. Yds.) to date
Current seal coat supplier
Application rate of current product
How do you market for new customers?
Do you own Industrial or Commercial Real Estate?
- Yes
- No
What is you knowledge of rejuvenators?
- Extensive
- Some
- None
Are you Hazmat Certified?
- Yes
- No
Are you willing to take Hazmat Training courses online?
- Yes
- No

Rejuvaseal USA Overview
Rejuvaseal USA Advantages
Steps to becoming a distributor
Distributor Application
Investments

Become A Distributor

© 2013 RejuvaSeal^® USA and Asphalt Pavement Technologies, LLC.

Asphalt Pavement Technologies is the master distributor and applicator for
Pavement Rejuvenation International, LP, the manufacturer of RejuvaSeal.

3625 Washington Pike | Bridgeville, PA 15017 | P. 412.377.0817 | F. 412.221.2569

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