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Channel Partner Application
Thank you for your interest in becoming a Biowater Technology Channel Partner. The Biowater Channel Partner Program is a program designed to target and qualifies potential channel partners that can leverage Biowater’s solutions. In order for us to prioritize your request for information and to qualify to become a Biowater Channel Partner, please complete the application below.

About your company and the contact persons
Company Address 1 Address 2 Zip State City Country or region covered Other countries/regions with offices Website Bus. contact person Title E-mail Phone Tech. contact person Phone Email

Please select the type of company you are
VAR (Value Added Reseller) - Provide sales, consulting and support Distributor Service Provider (BOT) If other, specify

Do you have experience in MBBR?
(Moving Bed Bioreactor)

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Yes

No

Do you have experience in IFAS?
(Integrated Fixed-film Activated Sludge) Yes No

Do you have experience in AS?
(Activated sludge) Yes No

Have your company turnkey WWTP experience?
No Yes, number of installation

Year your company was registered

Your firm is
Public Private

Number of employees

Number of Sales Representatives

Annual revenues in US dollar for the last fiscal year

Sales Territory Coverage
(Please explain where your product or solution sold)

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Company Overview / Strategic Direction
(Provide the company overview in paragraph format; Include company value proposition, key competitive advantages, and relevant customer or background information)

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Target market(s)

Municipals
New/Greenfield Upgrades

Industry
Food/Beverage Pharmaceutical Pulp & paper Mining/Petrochemicals If other, specify

Client references
(Please provide company name and market segment) Client 1 Client 2 Client 3 Client 4

Please provide a brief overview of your company's products or services

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Please describe the project or opportunity that you are working on
(including customer type, revenue potential, expected closing, competitor situation, customer relationship)

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Please describe any other partnerships that you may have that are important to your business

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In your plan, how Biowater can support you to achieve the sales target
(What sort of primary competence do your company have and what do you need/expect from Biowater?)

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Additional Comments and Questions
Please submit any additional comments or questions here

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Submit
Biowater Technology AS | Rambergveien 5 | 3119 Tønsberg | Norway Biowater Technology US LLC | 2155 Diamond Hill Road, Suite 2, Mailbox 4 | Cumberland, RI 02864 | USA www.biowatertechnology.com

http://app.emarketeer.com/ext/form/survey.php?m=166784aa3a81d9c15d9a1d3c90886d1... 12/11/2013