Library > Business Forms > Distributor Request

Request to Become a Valued Ray-Bar Distributor

RAY-BAR ENGINEERING CORP
CONFIDENTAL
800-444-XRAY (9729) | Fax: 800-333-XRAY (9729)
sales@raybar.com

FOR MEDICAL AND INDUSTRIAL USE ONLY
NO SALES TO GENERAL PUBLIC
NOT FOR USE IN ANY RESIDENTIAL APPLICATIONS

Required Fields *
Contact Information
Company Name *
Company Type
Type of Business
Business Description
Years established
Distribution area
Company website
Address *
City *
State / Province *
Country *
Zip / Postal Code *
Contact First Name *
Contact Last Name *
Contact Title
Phone *
Ext
Fax Number
Email *
Ray-Bar products you are interested in
Do you currently offer any x-ray protective products?
If Yes, please list
Other Information
Message and Request
I AGREE TO THE TERMS AND CONDITIONS
Upload a document (2MB Max)
⨯
{FILE_NAME}
Add a File
  • A RAY-BAR SALES REPRESENTATIVE WILL CONTACT YOU SHORTLY AND A CREDIT APPLICATION WILL BE FORWARDED TO YOU.
  • THIS APPLICATION IS FOR THE DISTRIBUTION AND RESALE OF GENUINE RAY-BAR PRODUCTS AND NOT FOR APPLICANTS OWN USE.