Havtech Dealer Distributor Program Sign-Up Form

Daikin Dealer Program Sign-Up Form

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First Name(Required)

Last Name(Required)

Contact Email(Required)

Business Phone Number(Required)

Company Name(Required)

Company Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Do you have a Havtech Customer ID?(Required)

This number can be found on Havtech Invoices

Havtech Customer ID

Are you a licensed HVAC contractor in Maryland or Virginia?(Required)

MD / VA HVAC license number

Do you have a CFC License?(Required)

CFC license number

Primary Ductless Brand(Required)

Total Ductless/Light Commercial HVAC Spend(Required)

Other Primary Ductless Brand:

What percentage of your business is Ductless Equipment?(Required)

What percentage of your business is Light Commercial RTU's?(Required)

What percentage of your business is Unitary Equipment?(Required)

Name

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