Contractor Application

Company Contact Information

Company Name:*

Address:*

(No PO Boxes)

City:*

State:*

Zip:*

Sales Phone:*

Website:

Sales Email:

Additional Company Information

Hours of Operation:

Time Zone:

–

–

Brief Company Description:

Contact Information

First Name:*

Last Name:*

Title:

Email Address:*

Phone Number:

Who is your preferred Distributor?

User Login:*

Password:*

Confirm Password:*

Security Question:*

Answer:*

Warranty Registration

Marketing Materials

Lead Generation

Modine authorized contractors are able to participate in our lead generation program by allowing customers to email you a request for quote.

By opting into the lead generation program your sales email will be used by the Where to Buy section on Modinehvac.com to send your lead emails.

Modine authorized contractors are able to participate in our lead generation program by allowing customers to email you a request for quote.

Lead emails must be answered within 48 hours. If leads are not being answered Modine reserves the right to cancel your ability to accept leads from our system.

Yes, I would like to receive lead emails from the
"Where to Buy" page on Modinehvac.com and

Yes, I agree to the Terms & Conditions of accepting lead

(Terms of receiving leads from ModineHVAC.com)

Rewards program

Heat Loss Calculator

Qualifying questions

Have you sold/installed Modine Heaters in the past 12 months?*

Do you accept service calls on Modine heaters your company did not sell/install?*

Distance willing to travel in miles?*

Yes, I agree to your terms and conditions*
(Terms and Conditions)
* Required

Thank you for your interest in becoming a Modine Authorized Contractor

Based on the following responses we are unable to approve your application at this time:

Would prefer not to service or install Modine units that were not purchased through .

If you have any questions regarding your application, please call 1-800-828-HEAT or email bhvaccontractors@modine.com

Original Values
City	State	Zip


Possible Alternatives
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