DISTRIBUTOR APPLICATION
Private and Confidential

WE ARE ACTIVELY SEEKING DISTRIBUTORS WORLD-WIDE!

 We are pleased that your company is interested in becoming a distributor for FuelSaver Technologies™ products.  If selected as a distributor, you will be an independent marketer of these products in your sales area.  We are not a network marketing company.  Consequently our product costs and profit potential for distributors are attractive and based on retail sales volume.  All purchases are in case lots.  We intend to work with you to assure your success in securing and maintaining many satisfied customers.  Please complete the following application:

Company Name
Company Point of Contact/Position
Street Address
City
State or Province
Country
Zip or Postal Code
Work Phone Number
E-mail Address
Which of the following best describes your type of business?	Importer Wholesale Distributor Retail Distributor Wholesale and Retail Other
Please Describe 'Other':
In what states or cities, provinces or regions do you currently serve or plan to serve?
What products do you plan to sell?
2 oz. Bottles for Gas/Diesel Gallon Bottles for Gasoline 55 Gallon Drum for Gasoline 350 Gallon Tote for Gasoline Tanker Truck for Gasoline	16 oz. Bottles for Gas/Diesel Gallon Bottles for Diesel 55 Gallon Drum for Diesel 350 Gallon Tote for Diesel Tanker Truck for Diesel
Image Validation: Please enter the characters in the image to the right. All letters are lowercase. Characters: Add me to your e-mail listing