* Required Field
Your name:
*
Email:
*
Company:
*
Phone:
*
Web site:
Address:
*
State:
*
Zip code:
*
Are you:
Web store
Individual shop/installer
Retail store
Who is your current AlphaTherm supplier (if applicable)
Comments:
Do you allow us to publish your information on our web site?
Please type YES or NO
We are currently collecting information regarding AlphaTherm Heated Wash dealers/installers in order to publish a list on
our website. The published information will have your business name, address, and telephone number. This published
information will appear on a “Where to Buy” page to help customers locate dealers in their area, where they can purchase
and obtain installation of Heated Wash products. If you are currently a dealer and would like to appear on our website, or
would like to become a dealer, please supply the following information.
(We keep your personal information confidential. We do not sell or rent your personal information to third parties.)
Dealer Registration Form
(We keep your personal information confidential. We do not sell or rent your personal information to third parties.)