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Forms > Ecologix Clear Alliance Program Member Request

Your customers rely on you to bring them industry-leading technology in air & water-treatment solutions. You want to provide the answers that fuse innovation, efficiency and reliability into the one integrated product that will save them money like never before. Set new standards for more satisfied customers - around the globe.

Ecologix Environmental Systems designs, engineers and distributes the most comprehensive range of innovative solutions currently available in Air & Wastewater Treatment. We will be here to provide you with industry-leading solutions, the latest technology and cutting-edge resources everystep of the way. Join Ecologix and let us provide you with the tools to become the strongest link in your customers' operations.

The Ecologix CLEAR ALLIANCE Distributor Program. We are currently expanding our opportunities for sales reps throughout North America and adding distributorships worldwide, and are interested in hearing from you! We are looking for companies who are passionate about providing customers with the absolute best solutions for Wastewater and Air treatment - and who are good at it!

If you are interested in becoming a part of our team, please complete the form below or download the FULL DISTRIBUTOR APPLICATION FORM, fax back to us (ATTN: Clear Alliance (678) 514-2106) and we will be in touch with you directly.

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 Program Manager at 678-514-2100.

Contact Information
Company Name
Contact Name (First/Last) First: Last:
Head Office Address
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
Bag Filters
Physical Chemical Treatment Systems
Biological Treatment
Filter Screens
Wet Scrubbers
Oil Water Separators
Filter Press
Reverse Osmosis
Specialty Chemicals
Which of the following Industries/Applications do you service
Food Processing
Iron Removal
Metal Plating
Odor Control
Car Wash Industry
Latex Removal
Petrochemical Industry
Commercial Laundry
Metals Removal
Municipal Wastewater
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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