UltraHeat, Inc. - Become an Authorized Dealer

Please fill out the form below. Verification/authorization make take up to 2 or 3 business days. We will e-mail you following verification/approval.

Please complete the following required information fields.

Information provided is for registration purposes only, and will not be shared with others.

Check all that apply:	RV Dealer Member of RVDA Independent Service Shop
	How did you find out about us?

Company Name
Contact First Name		Last Name
Shipping Address
Shipping Address 2
City
State/Province/Territory	International Customers - Please select "Not in USA or Canada".
Zip or Postal Code
Country

E-mail
	Please be careful to provide an accurate e-mail address. It is necessary to process your application.

Business Phone		Fed ID# or GST #
		Sales Tax # or PST #

	Billing Address (if different)
Address
Address 2
City
State/Province/Territory	International Customers - Please select "Not in USA or Canada".
Zip or Postal Code
Country

	Canadian Customers Only
	Please check this box if your sales rep team is Bob & Char Burlingame.

	International Customers Only
Name of Import Broker (if applicable)
Phone of Import Broker (if applicable)

The Following Information is Required to Access the Dealer Website

Enter YOUR choice of User ID and a combination of letters & numbers you wish to use as your password. Passwords must be minimum 6 characters (maximum 20 characters). No symbols please. Passwords are case sensitive.

Enter User ID		Password
		Repeat Password