Contact Information Company Name* First Name Last Name Address Line 1* Address Line 2 City* State* —Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip/Postal Code* Phone Number Please verify you have entered a valid phone number. Cell Number Please verify you have entered a valid cell phone number. Fax Number Please verify you have entered a valid fax number. Email Address Please check that you have entered a valid email address. Website URL Dealer Questionaire Primary Distributor* Secondary Distributor* Type of Dealer* Plumbing & HeatingMechanical ContractorHVAC DealerFuel Oil DealerOther Services* InstallationService/ReplacementReplacementOther Number of Employees* 1-45-1011-2021-5051-100Over 100 Customer Base* —Please choose an option—ResidentialCommercialInstitutional How many boilers do you typically install annually? Have you or your staff attended factory technical training?* —Please choose an option—YesNo Are you or your staff be interested in attending factory technical training? —Please choose an option—YesNo Comments Do you offer service programs?* —Please choose an option—YesNo Comments
