Authorized Installer Setup InstagramThis field is for validation purposes and should be left unchanged.Fill out the form below to request setup for your Installer as a DuraMAX Authorized Installer. Questions? Contact UsThis field is hidden when viewing the formPost Title Distributing Company(Required) RELADYNE Other Sales Rep Name(Required)Sales Rep Email(Required) Installer DataData entered in this section will be how the DOLLAR$ checks will be payable and how the Installer will be listed on the Locator Map.Installer Company Name(Required)Street Address(Required)City(Required)ST(Required)Zip Code(Required)Installer Phone NumberIf 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(Required)Installer Contact Email Address(Required) Account NumberProgram ParticipationSelect the DuraMAX Programs in which the Installer will participate.(Required) DuraMAX DOLLAR$ Program Engine Warranty Program List this Location on DuraMAX.com Select AllAcknowledgementRequesting setup of your Installer through this form does not trigger Point of Sales Materials to be sent.(Required) I acknowledge that I will need to work with my Marketing Department to order Point of Sale Materials to support these Programs.
