Application for Insitu® Spray Applied Coating Certified Applicator Program

Application for Insitu^® Spray Applied Coating Certified Applicator Program

Join the World Leader in Fighting HVAC Corrosion

Did you know that Modine is now looking for partners to join its Global Network of trained and certified applicators for Insitu ES2 Corrosion Coatings? Use the form below to complete an application!

Company Name

Date

Primary Contact Name

Title

Email

Cell Phone

Facility Street Address

City

State

Country

Mailing Street Address

City

State

Country

Office Phone

Office Fax

Company Website Address

Does your company have a Facebook page?

YesNo

Facebook Page URL

Does your company have a LinkedIn page?

YesNo

LinkedIn Page URL

How many years in business under this name?

How many locations?

Total number of employees?

Total number of service employees?

Number of office personnel?

Total number of sales reps?

Do you apply or represent any coating companies presently?

YesNo

If Yes, which ones?

Does your company Distribute HVAC Equipment?

YesNo

If Yes, which ones?

What are your annual sales?

This Year to Date

Last Year

If you currently have multiple locations, what cities are they located?

Describe your company’s products and services.

How Many Sq Ft do you have available for coating operation?

What is the largest piece of equipment you can safely handle? (Off load, coat, reload)

Describe how Modine's products and services benefit your company's sales or service programs:

Describe the type of assistance you expect from Modine and its representatives:

List the geographic areas presently serviced by your company.

Are you close to any OEM Distribution Centers? If yes, which OEM and how close to your location?

Will you prefer to be trained at our Florida location, or at your location?

Which dates work best for your training?

First Preferred Date

Second Preferred Date

Third Preferred Date

How many employees will you want to train to become Modine Certified Applicators?

Enter names of Applicator trainees, if known.

Authorized Company Signature

Title

Date

Please upload images of your facility, inside and outside for us to get to know you better.

Verification

Please allow 4-6 weeks from time of contract signing to implement training.

Application for Insitu® Spray Applied Coating Certified Applicator Program

Application for Insitu^® Spray Applied Coating Certified Applicator Program

Join the World Leader in Fighting HVAC Corrosion

Insitu Spray Applied Coating

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