Shop Account Request Form

Thank you for your interest in Koch Chemie! As a leading manufacturer of chemical innovations, we aim to provide global transportation with integrated systems and world-class service in sustainable surface care, cleaning and material protection.

We support the future development of our customers on-site with high-performance solutions and outstanding service, optimised to their needs, at competitive prices.

Partnership Type

Please Choose What Describes You Best *

Business Information

First Name *

Last Name *

Business Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Questionnaire

Potential Opening Order *

Do you operate a detail business?

Do you have a mobile operation or a storefront in addition to your services?

Is the business existing already? If so, how long?

Do you (or do you intend to) sell product online? (Amazon not permitted)

Are you replacing anything in your offering with Koch-Chemie?

Why Koch-Chemie?

All answers provided are accurate and true - Please Sign

Signature *

clear

Additional Comments

Notes

Save & Return

Use an account to return to saved work.

$250
$500
$1,000
$2,500
$5,000
$10,000
$15,000
$20,000+