Authorized Installer Setup

Fill out the form below to request setup for your Installer as a DuraMAX Authorized Installer.
Questions? Contact Us

Post Title

Distributing Company*

Sales Rep Name*

Sales Rep Email*

Installer Data

Data entered in this section will be how the Service Certificate checks will be payable and how the Installer will be listed on the Locator Map.

Installer Company Name*

Street Address*

City*

ST*

Zip Code*

Installer Phone Number

If included, will be listed on Locator.

Installer Website (include http://)

If included, will be listed on Locator.

The following information is used for notifications and record keeping.

Installer Contact Name*

Installer Contact Email Address*

Account Number

Select the DuraMAX Programs in which the Installer will participate.*

Requesting setup of your Installer through this form does not trigger Point of Sales Materials to be sent.*

I acknowledge that I will need to work with my Marketing Department to order Point of Sale Materials to support these Programs.

Name

This field is for validation purposes and should be left unchanged.