Dealer Application Form

Chambers Pure Water System works hard to provide the support and opportunities needed to succeed. However, your success depends upon your skills, resources and personel efforts, as well as market conditions.

Please note that the submission and acceptance of this questionnaire should not be construed as an approval or a guarantee of becoming a Chambers Pure Water System franchisee. If you are selected you will be contacted for a formal interview. Please allow approximately 30 days for a written response

Fields in bold are mandatory
First Name:  
Last Name:  
Email Address:  
Telephone Number:  
Date Of Birth: (m/d/y)
Marital Status:
Do you plan on being a full time or part time CPS Dealer:
 
Will you be entering into a partnership with another party to become a dealer for CPS?
 
Do you have retail or in-home sales experience?
 
Please enter the anticipated amount you plan on investing:
Where did you hear about us?