Dealer Registration Form

Please allow up to 72 hours for registration to be processed and access granted

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Account Number*

Dealer name*

Date*

Branch Location and Number*

First Name*

Last Name*

Address (please include city, state & zip code)*

E-mail Address*

Phone Number*

Describe your company *

No. of Trucks*

Current Equipment Brands (i.e. ThermalZone, etc)*

Username (for use on URHVAC.com)*

Preferred Email Address for URHVAC*

Only fill in if you are not human