Authorized Internet Reseller Application

Please complete the following form to be considered for Entropy Resins’ Authorized Internet Reseller Program.

Entropy Resins Authorized Internet Reseller Program

"*" indicates required fields

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Record Type

Contact Information

To better serve you, please provide us the following contact information for your organization:

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General Manager

General Manager*

First Last

General Manager Email

General Manager Phone

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Purchasing Contact

Purchasing Contact*

First Last

Purchasing Contact Email

Purchasing Contact Phone

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Accounts Payable

Accounts Payable*

First Last

Accounts Payable Email

Accounts Payable Phone

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Price Change Contact

Price Change Contact*

First Last

Price Change Contact Email

Price Change Contact Phone

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Marketing Contact

Marketing Contact*

First Last

Marketing Contact Email

Marketing Contact Phone

Acceptance of Terms

Complete the following to accept the terms outlined in the Entropy Resins Authorized Internet Reseller Agreement and Unilateral Price Policies.

Date*

Your Name*

First Last

Your Title*

Your Email*

Entropy Resins Authorized Internet Reseller Application

Entropy Resins Authorized Internet Reseller Program

Company Information

Contact Information

Acceptance of Terms