Distributor Application

Please complete the form below and a Yates Cylinders representative will contact you shortly.

First Name*
Last Name*
Title*
Company*
Email*
Phone*
Fax
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
What territories/states do you service?
How many outside salespeople do you employ?
Do you represent any competing lines to Yates? If so, which product and who are the manufacturers that you represent?
Please estimate your annual purchases from Yates this year and next.
Current
Next
If we need to request credit information about your company, who should we contact?
How did you hear about us?
How did you first find our web site?
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