AQUA FLORA INTERNATIONAL INC.

P.O. BOX 666,  CARROLL, IA 51401

1-800-237-4100  ■ TEL:712-775-2050 

FAX:712-775-2051

www.aquaflorainc.com  info@aquaflorainc.com

If you are interested in retailing Aqua Flora products and have an established retail store or e-commerce business, please fill out this form and      fax to 712-775-2051.  Once your information is received we will respond promptly with wholesale pricing and policies.

Business Address and Contact Information              

Business Description                              

Business Name:
 Area Served:
Address Line 1:
 Store Area Sq. Ft. 
Address Line 2:
 Number of Stores:  
City:
 Business Reg. #:
State:
 Years Est.:
Zip:
  #  of Employees:
Country:
 Years Web Est.:
Phone:
 Sell on Line?
Fax:
 Site Secure?
Web Site:
 Other info.:
Primary Contact:
 1.
Title:
 2.
E-mail Address:
 3.
Contact Phone Number:
 4.
   

Thank you for your interest in Handling Aqua Flora Products!

BACK