Dealer Application

Thank you for your interest in Aqua-Tech Co. Distribution! 

Please fill out the following fields and a member of our staff will contact you to open an account.

You can also call us at 847-383-7075 or email at

Please Note:

Submission of form does not ensure your account is opened. Customers will be required to submit additional information and sign Aqua-Tech Co.’s dealer and MAP agreement to open an account. 

The full dealer form can be downloaded here and must be signed and completed in full to qualify for an account. Dealers can Fax the form to 847-787-5123 or email to accompanied by a business license and/or tax information.

Company Name:
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Email Address:
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