Become a Dealer

Piscine Energetics Dealer Application Form

Thank you for your interest in becoming a Piscine Energetics dealer! While the following application is extensive, it ensures that only the most qualified applicants join the Piscine Energetics dealer program.

Contact Information

Account / Store Name*

Alternative Name (DBA)

Region*

Canada
United States
United Kingdom
Mexico
Central / South America
Africa
Asia
Middle East
Europe

Type of Business*

Retailer - Single Location
Retailer - Multiple Locations
Tank Maintenance & Service Company
Distributer
Online only

How many stores do you have that would be carrying our product?*

Do you offer Tank Maintenence?*

Yes
No

Do you sell online?*

Yes
No

Do you offer delivery with:*

Select All
Company owned vehicles
Freight Companies
Customer Pickup

What is your delivery area / Reach with company owned vehicles?

How many delivery trucks do you have in your fleet?*

Do you deal in dry goods or live fish?*

Select All
Dry Goods
Live Fish

Which States do you cover?*

Which Province/Territory do you cover?*

How Many Accounts do you cover?*

Are you the owner?*

Applicant Name*

First Last

Title*

Applicant Phone Number*

Applicant Email*

Owner Name*

Prefix First Last

Owner Phone Number*

Owner Email*

Alternative Contact

First Last

Title

Product Information and knowledge level

Products interested in*

Select All
Frozen Product
Dry Product

What frozen fish food lines do you currently carry?*

What dry food lines do you currently carry?*

At what level of comfortability is your staff on speaking about fish nutrition with a customer?*

Beginner
Intermediate
Advanced
Expert

Business Information

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Store Phone Number*

Store Email*

Fax

Total Store Square Footage*

Are you a:*

Full Line Pet Store
Freshwater Only Fish Store
Marine Fish / Coral Only Store
Freshwater and Marine Fish / Coral Store

How many gallons are your freshwater systems?*

How many gallons are your marine systems?*

Year Established

Website

Facebook Page

Twitter

Instagram

Please upload pictures of your store front*

Drop files here or

Max. file size: 5 MB.

Please upload photos of the inside of your store.*

Drop files here or

Max. file size: 5 MB.

Please upload photos of your freezer, both inside and out.*

Drop files here or

Max. file size: 5 MB.

Please upload photos of your display tanks.*

Drop files here or

Max. file size: 5 MB.

Billing Information

Same as Store Info

Check if billing information is same as store

Billing Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Billing Phone Number*

Billing Email*

Fax

Business References

Please Provide at least two business references.

Reference #1 Name*

First Last

Reference #1 Company Name*

Reference #1 Company Website

Reference #1 Phone Number*

Reference #1 Email*

Reference #2 Name*

First Last

Reference #2 Company Name*

Reference #2 Phone Number*

Reference #2 Company Website

Reference #2 Email*

Business Account Login

Login credentials will be activated if approved.

Username*

Account Email Address*

Password*

Enter Password Confirm Password

Additional Comments

CAPTCHA

Interested in becoming a PE Retailer?

Become a Dealer

Piscine Energetics Dealer Application Form

Contact Information

Product Information and knowledge level

Business Information

Billing Information

Business References

Business Account Login

Interested in becoming
a PE Retailer?