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 Applications
 Automotive
Biodiesel
Dairy Industry
Industrial Wastewater
Food Processing Industry
Iron Removal
Latex Removal
Metals Treatment
Mining Industry
Municipal Wastewater
Odor Control
Petrochemical Industry
Poultry Industry
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Activated Carbon
Bag Filtration
Biological Treatment
Chemicals (Specialty)
Clarifiers
Controls
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Forms > Ecologix Clear Alliance Member Request

This application is for Industrial Distributors who would like to register as an Ecologix Clear Alliance Member. The undersigned acknowledges that this is an application for only, which may or may not be accepted by Ecologix Environmental Systems based on its evaluation of qualifications and assessments of program needs. Questions? Please call the Ecologix Clear Alliance Manager at 678-514-2100.
Contact Information
Company Name
Contact Name (First/Last) First: Last:
Head Office Address
Street
City, State City: State:
Country, Zip Country: Zip/Post Code:
Telephone / Fax Phone: Fax:
Email Address
Please provide contact information for your Head Office Management staff
General Manager
Phone / Cell Phone: Cell:
Sales Manager
Phone / Cell Phone: Cell:
Marketing Manager
Phone / Cell Phone: Cell:
Company Website Address
Financial Information
In order for Ecologix Environmental Systems to complete a credit check we require the following information
Bank / Branch / Account Number Bank: Branch: A/C Number:
Bank Contact / Phone Contact Name: Phone:
Federal Tax ID / D&B Federal Tax ID: D&B:
About Your Business
Number of Employees
Number of Branch Offices
Will all branch offices be participating in the Ecologix Environmental Clear Alliance Program? Yes No
Are your branch offices Wholly owned subsidiaries Individually owned franchises?
Number of years this company has been in business
Which other Vendors do you currently represent?
Are you a Distributor Wholesaler Manufacturer Sales Agent. Other
Which of the following products do you manufacture, distribute or sell? (Please check all that apply)
Integrated Treatment Systems
DAF Systems
Filters
Bag Filters
Physical Chemical Treatment Systems
Controls
Biological Treatment
Clarifiers
Filter Screens
Evaporators
Wet Scrubbers
Oil Water Separators
Pumps
Filter Press
Reverse Osmosis
Specialty Chemicals
Other:
Which of the following Industries/Applications do you service
Food Processing
Rendering
Automotive
Iron Removal
Metal Plating
Aerospace
Dairy
Odor Control
Car Wash Industry
Latex Removal
Mining
Pharmaceutical
Poultry
Petrochemical Industry
Commercial Laundry
Metals Removal
Municipal Wastewater
Other:
Has your company ever worked with Ecologix prior to your application today? Yes No
If so, in what capacity?
Has your company ever worked with a competitor of Ecologix? Yes No
If yes, please list:
What is your specific sales territory/region? Please be specific. We are looking for targeted sales areas, not general territories.
Do you agree to meet the following eligibility criteria Yes No
  1. Demonstrate that owner/senior staff have experience promoting and selling energy efficient equipment and/or projects (where applicable)
  2. Maintain a valid Business License that has been in effect for at least the past two years and provide Ecologix Environmental Systems with evidence of such license upon request.
  3. Purchase and maintain the appropriate bonding required for this license, as required.
  4. Provide Ecologix Environmental Systems a list of at least five (5) large implemented wastewater treatment or air treatment projects as references (where applicable).
  5. Maintain a place of business and notify Ecologix Systems of the street address.
  6. Submit a Clear Alliance application with Ecologix Environmental Systems.
  7. Comply with all rules of Ecologix Environmental Systems Clear Alliance Distributor Partnership Program.
  8. Accurately represent customer water uses and consumption estimates where required.
  9. Proof of company financial stability: ie. Permission for Ecologix Environmental to conduct a credit check.
Please Provide References
Company name / Phone (Reference 1) /
Contact name
Company name / Phone (Reference 2) /
Contact name
Company name / Phone (Reference 3) /
Contact name
Company name / Phone (Reference 4) /
Contact name
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