Authorized Installer Setup

Fill out the form below to request setup for your Installer as a DuraMAX Authorized Installer.
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Post Title

Distributing Company*

Sales Rep Name*

Sales Rep Email*

Installer Data

Data 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*

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.

Phone

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