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RSG Distributor Signup Form

Please fill out the form below as completely and thoroughly as possible. As soon as you are approved you will be contacted with instructions on completing the Distributor signup process.
About You (Primary Contact)
Salutation: Mr. Mrs. Ms. Dr.
First name* Last name*
Suffix Jr. Sr. II IV
Title Describe your reponsibilities
Email Address*: Phone*
Fax
Company Information
Company Name* Division
Subsidiary of
Mailing Address*
City* State/Province*
Postal code* Country*
Telephone* Ext.
Fax
Shipping Address
(if different)
City State/Province
Postal Code  
Company Profile
Please provide a general description of the services your company provides.*
Company President Number of years in business
Number of full-time employees Current Annual Revenues (in U.S.$)
Sales Distribution Areas:
North America: South America:
Europe: Asia/Pacific Rim:
Africa: Other:
Primary markets (percentages):
Genral Retail: Crafts:
Screen Printing: Manufacturing:
Concrete: Glass:
Art: Candles:
Plastics: Signs:
Beauty: Toys/Novelty:
Jewllery: Murals:
Other:
Who are your major competitors?
What trade shows do you generally attend?
What trade organizations do you belong to?
Product Information:
Which of RSG`s products are you interested in distributing?
Product type
What states or territories do you sell in?*
* Are required fields
  Glow Powder
    Daytime Invisible
    Daytime Neon
  Glow Paints
    Daytime Invisible
    Daytime Neon
    Black Light
    Fabric
    Heat `N Dip
    Spray Paints
  Glow Hair/Body gel
  Glow Vinyl / Glow Paper
  Master pellets
  Gravel/Rocks
  Stencils
  Business Solutions
  MSDS
  Product Comparison

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(All orders over $15)
Ceiling constellations, Glow fishing lures, Luminescent Gun Sights using our glow paints, pigments and powder.
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