*Name   Company

Street  

City   *State   *Zip *County

*Telephone     *E-Mail   Website

Geographic area being applied for:
     *First Choice  
 Second Choice

Type of dealership being applied for: Limited Primary Marketing Rights Please Select

   LIMITED DEALERSHIP means that you will have the right to offer Waterloov to your client base in your
geographic area. (does not including marketing rights to the general population).

    PRIMARY MARKETING RIGHTS means that you will have the primary rights for marketing the 
Waterloov® trade name and patented design to the general public in a specific geographical territory.

          Please tell us about your Gutter Protection application
 and any other comments you may have.