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 Wholesale Dealer Application 
To apply for a wholesale account, please fill out and submit the form below. Fields marked with an asterisk (*) are required.

Please be sure to provide us with a valid email address so that we can notify you once your account has been approved and activated.

We require that your first wholesale order be for a minimum of $1,000. There is no minimum order requirement on subsequent orders.

Personal Information
First Name:
 *
Last Name:
 *
Phone:
 *
Email Address:
 *
 
Business Information
Company Name:
 *
Business Phone:
Business Email:
Business Fax:
Website:
Tax Number:
 *
Consumer Products Reseller
Full Line Professional Dealer
 
Billing Address
Address:
 *
City:
 *
State:
 *
Zip Code:
 *
 
Shipping Address (if different)
Address:
City
State:
Zip Code:
 
Additional Information
How Did You Find Us?:
Internet
Trade Show
Advertisement
Personal Referral
Other
 
Will You Be Selling Our Products Online?:
Yes
No
 
Please Select the Category That Best Applies to Your Organization:
Retail Store
Manufacturer
Water Treatment Professional
Plumber
Practitioner/Clinic
Food Service
Internet Only Store
 
Additional Comments or Questions:
 
Mailing list signup:
 Check this box to signup for our site mailing list.
 
By clicking "SUBMIT" you are verifying that you have read and agreed to our "Terms & Conditions" and "Dealer Agreement."
 
Security code:
 *
Do not enter anything in this field:

* indicates a required field
Serving your water treatment needs since 1986


LivingWaters™ Engineered Water Treatment Solutions
 P. O. Box 7261
Woodland Park, Colorado 80863
Phone: 719-687-2928

To email us, click here.

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