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LIVE EVENTS

NEW END USER INTAKE

DISTRIBUTOR NAME*

End User/ Collision Center Name*

Owner/Manager Contact Name*

Phone*

Email*

Street Address*

City*

State*

Postal Code*

Approx. sq ft.

Approx. gross sales

# Paint Techs

# Body Techs

MSO # locations

Opening Order

EQUIPMENT

AC850+cart

CirqualiQ

SPRAYABLES - Red Top 1.0L Cans

LuxPrime

LuxPrime-DARK

RPC-UV

UV EPOXY

UV BODY FILLERS

FirstFill®

FinishFill®

ChipFix2.0™

AEROSOLS

LuxPrime - aero

LuxPrime DARK - aero

UV- EPOXY - aero

Additional notes :

Name of person submitting form*

Email of person submitting form*

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