Distributor Application

Thank you for inquiring to become a distributor or reseller account. Please fill out this form with your company information to submit an application.

Reseller Application

First Name *

Last Name *

Email Address *

Your corporate email - not Gmail.com or Yahoo.com

Phone Number *

Please provide a daytime number where we can reach you.

Company Name *

Company Website *

Company Address

Please provide the primary address where your company is registered.

Address *

Address

Address

Address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

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Country

Company Information

Years in Business < 1 Year1 year or more5 years or more

Annual Revenue (In USD equivalent) Below USD $500,000$500,000 - $2,500,000> $2,500,000

Number of Employees 1-1010-50More than 50

DUNS Number

Dun and Bradstreet Number (Lookup https://www.dnb.com)

Describe your products and services

Please see agents page to understand our distributor or reseller requirements.

Applying For (check one) *

RESELLER

DISTRIBUTOR

Please describe the territory and target market for Nova products *

Nova Products of Interest

Dyes for Lubricants and Fuels

Dyes for Leak Detection

Aerobatic Smoke Dyes

Other

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