How to Become a FINA Branded Dealer or Distributor

Instructions: Please complete the following form and we will provide you with additional information regarding image expense, program and payment card fees and branding incentives.

To discover the advantages of becoming a FINA branded store, please complete this form.

*First Name:

*Last Name:

Title:

*Company:

*Company Type: Distributor     Dealer

*Company Address:

*City:

*State:Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ---U.S. Territories---- American Samoa Guam Northern Mariana Islands Puerto Rico U.S. Minor Outlying Islands Virgin Islands of the U.S. ------Canada------ Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ------Mexico------ Aguascalientes Baja California Baja California Sur Campeche Chiapas Chihuahua Coahuila Colima Distrito Federal Durango Guanajuato Guerrero Hidalgo Jalisco Mexico Michoacan Morelos Nayarit Nuevo Leon Oaxaca Puebla Queretaro Quintana Roo San Luis Potosi Sinaloa Sonora Tabasco Tamaulipas Tlaxcala Veracruz Yucatan Zacatecas Other

*Zip Code:

*Telephone Number:

*Email Address:

Company Website:

*# Total Sites Supplied:

Total Volume Supplied:

*General Location of Stations:

Comments:

 

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