Distributor Application

Please fill out the form below to apply to become a distributor of IC Scientific Solution Products. Upon receiving your application, we will review your information. Once approved, we will reach out to you with next steps.

Name *

First

Last

Email *

Billing Company Name *

Billing Address 1 *

Address 2

City *

State *

Zip Code *

Country *

Shipping Company Name *

Shipping Address *

Address 2

City *

State *

Zip Code *

Country *

Website URL *

Number of employees *

Business (Check all that apply) *

Distributor
Retail Store/brick-and-mortar
Online Retailer

Agreement *

Proprietary Information defined as any information, technical data, or know-how (including, but not limited to, information relating to products, software, services, development, inventions, processes, techniques, customers, pricing, internal procedures, business and marketing plans or strategies, finances, employees and business opportunities) disclosed by IC Scientific Solutions to the “Recipient Party”) either directly or indirectly in any form whatsoever, including, but not limited to, in writing, in machine readable or other tangible form, orally or visually. Unless otherwise expressly authorized by IC Scientific Solutions, the Recipient Party agrees that it and any of its personnel receiving Proprietary Information under this Agreement shall treat such Proprietary Information in strict confidence with the same degree of care applied to its own Proprietary Information of like importance, which it does not wish to disclose, publish, or disseminate to third parties.

Recipient Party Name (Company Name) *

ICONIC CLEAR

EpiFreeze

ICONIC CLEAR CRYOANTIFOG
1OZ SPRAY

ICONIC CLEAR ELECTRONICS MARINE & AVIATION WIPES

ICONIC CLEAR 1OZ MULTI-PURPOSE CLEANING SOLVENT

ICONIC CLEAR

EpiFreeze

ICONIC CLEAR CRYOANTIFOG 1OZ SPRAY

ICONIC CLEAR ELECTRONICS MARINE & AVIATION WIPES

ICONIC CLEAR 1OZ MULTI-PURPOSE CLEANING SOLVENT

ICONIC CLEAR CRYOANTIFOG
1OZ SPRAY