Hydrus Re-Sellers Registration Form

Re-Sellers Registration Form

Please complete the form below and a Hydrus representative will review your application. Once approved, you will receive login credentials via email to our Re-Seller Shopping Site where you will then be able to view wholesale pricing and complete purchases.

NOTE: We are currently only accepting applications for the United States and Canada.

First Name *

Last Name *

Company

EIN (Employer Identification Number)

6-Digit Representative Code (if applicable)

Street Address *

Street Address (cont)

                        
                        City *
                    
                        State/Province *
                    
                        Zip/Postal Code *

                        
                        Country *
                    
                        Phone Number *
                    
                        Email Address *

Reseller Location *

Other Reseller Location

How Many Members Do You Service? *

Reason to Resell Hydrus? *

* denotes required fields

I agree to the terms of the Hydrus™ MAP agreement.