Bio-Microbics is always looking for experienced, hard working people or companies to install and/or service Bio-Microbics products. If you wish to become a certified Bio-Microbics installer or service provider, please complete and submit the form below. Management will review your application and determine if you and/or your company might be a good match. Note: Bio-Microbics reserves the right to contact local regulators to inquire about you or your company's past installation/service experience. Required fields are marked with an *.

Name:*
Title:
Company:
Address:*
City, State, Zip:*
Country:*
Phone:*
Fax:
E-mail:*
Inquiring about: Installing  Providing Service Both
Current Licenses:
(please check all that apply)		 General Contractor
 Electrician
 Other:
Briefly Describe Past Installation/Service Experience:
Have you installed or serviced competing wastewater treatment products? Yes  No  I don't know

If Yes, which product? 
Have you ever attended a Bio-Microbics product training session? Yes  No
Number of Employees:
Territory Requested:* Example: Central Kansas
Where did you hear
about us?
(please check all that apply)		 Newsletter/Magazine Advertisement:
Internet/Search Engine:  
Popular Mechanics
Bio-Microbics Distributor/Dealer:
Word-of-mouth
Tradeshow:
Other:




Please only click the SUBMIT button once. The form may take a minute to process.