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Heat Siphon Dealer Kit Request Form

WELCOME !!

You are Cordially Invited to Join the Heat Siphon Nation!!

SEE WHO'S ALREADY A DEALER IN YOUR COUNTY - click here

To Request your FREE HEAT SIPHON DEALER KIT and apply to become a Heat Siphon Dealer, just complete the form below and click the SUBMIT BUTTON when done. If you would like a FREE webpage on our site - MAKE SURE YOU READ AND AGREE TO THE TERMS AT THE BOTTOM.

Your Need for SALES/PRICING Information:

Immediate Sales Upcoming Bid Future Reference

Your Experience With Swimming Pool Heat Pumps?

Heard of Them Tried One Sold Installed More Than One Brand

Enter THIS WORD:

Tell Us a Little About Your Business. Please use average figures where appropriate.

PART 1 - Company Information

(required) Company Name:
License No:
OWNER's Last Name:
 First Name:
Your Title:
 Middle Init:
(required) Address:
City:
ST (USA ONLY):
ZIP Code (USA ONLY):

For Pool Dealers OUTSIDE The USA (United States of America):
Province: Postal Code:
Country:
(required) Phone:
 FAX:
E-mail Address:
Store Hours:

POOL DEALERS - If you have a web page we'd be happy to LINK you to our Pool Site Links
Web Site URL:
Main Business:
SecondaryBusiness:
Your Specialty:
Your Business Strong Point:
Year Established:
  

IF YOU ARE IN A HURRY-STOP HERE

Submit this form Now and JUST CALL US TOLL FREE!! 800-447-9667

OR DON'T SUBMIT AND Continue to expedite your dealer credit application.

PART 2 - Business Information

ALL FINANCIAL INFORMATION WILL BE KEPT STRICTLY CONFIDENTIAL
Tell Us a Little About Your Business. Please use average figures where appropriate.

Swimming Pool / Spa Sales

Pool Sales$:

Pools/Yr:
CHECK ALL
THAT APPLY
 Residential
Commercial
Above Ground
Inground
Indoor
Concrete
Vinyl Liner
Fiberglass
Pool w/Spa
Spas
Swim Spas
Suanas
Fountains
Waterfalls
Pool Enclosures
Pool Service
Pool Openings/Closings
Pool Leak Detection
Chemical Delivery
Winterizing
Free Water Analysis
Pool Pump Repair
Pool Toys & Games
Safety Equipment
Pool Slides
Diving Boards
Landscape Lighting
Underwater Lighting
Pool Alarms
Test Kit
Pool Furniture
Deck & Patio Constr

Pool Brands Sold

Spa Brands Sold
Primary Franchise: Secondary Franchise:

 

 What Other Major Brand Names Do You Sell ?
Pool / Spa Heater Sales

ALL Heater Sales$:

Heaters/Yr:

Heater Brand(s):
Preferred Heater Brand(s) % Profit Qty Sold / Yr
Natural Gas
Propane
Oil
Solar
Heat Pump
 

What features & benefits do you stress when selling heaters?
Why do your customers heat their pools?

 

How would you improve pool heaters?
What features would you add or change or delete?
Historic Heater Sales: CHECK ALL types or brands you have sold or sell
Type/ Brands of Heaters: Natural Gas Heaters
Propane Heaters
Oil Heaters
Solar Heaters
Heat Pumps 		Air Pro
Aqua-Cal
Gulf Stream
Heat Siphon
Jandy
Pentair
Teledyne Laars
Raypak
Hayward
Purex
Sta-Rite
Other

PART 3 - FREE WEB PAGE SECTION

The Following information will be used for your free webpage on our site at WWW.HEATSIPHON.COM/YourPoolCompany

This information also tells us more about your preferences and needs, so please complete it EVEN IF YOU DON'T WANT A FREE WEBSITE:

BRAND NAMES you would like to List on Your Free Web Page:
Pool Pumps Alternate
Filters Alternate
Pool Cleaners Alternate
Pool Covers Alternate
Chemicals Alternate
Other Brands or Specialty Services you would like listed
Company Motto

Free Website Terms

I understand that United States ThermoAmp Inc. is the publisher of all information I provide to them, and is offering to publish this information free of charge to me at their sole discretion on one web page and as such they may terminate publication at any time. Additional pages may be provided for a fee at a later date but this single html web page will remain free to all valid Heat Siphon Dealers. Heat Siphon is a trade mark of United States ThermoAmp Inc. All other logo's or trademarks published herein are the property of their respective owners. All rights reserved. copyright 1998-2011 United States ThermoAmp Inc.

I agree to hold United States ThermoAmp Inc. harmless from any liability for any errors, omissions or inaccuracies in the information I have provided above and any and all losses or damages that may result.

NOTICE BY FILLING IN YOUR NAME YOU AGREE TO THESE TERMS

I hereby certify that the above is true and correct information and that I have read, understood and agree to the terms above.

NAME OF PERSON APPLYING FOR FREE WEB SITE:

If you want to use our ONLINE ORDERING Please enter the following:



Tee Shirt Size

THANK YOU for Applying to become a HEAT SIPHON DEALER - We will be contacting you shortly by phone.