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Daikin Dealer Program Sign-Up Form
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First Name
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Last Name
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Contact Email
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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)
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No
This number can be found on Havtech Invoices
Havtech Customer ID
Are you a licensed HVAC contractor in Maryland or Virginia?
(Required)
Yes
No
MD / VA HVAC license number
Do you have a CFC License?
(Required)
Yes
No
CFC license number
Primary Ductless Brand
(Required)
Amana
American Standard
Armstorng
Bryant
Carrier
Coleman
Daikin
Goodman
Lennox
Other
Total Ductless/Light Commercial HVAC Spend
(Required)
$0-50k
$50k-100k
$100k-200k
$200k-300k
$400k-500k
$500k-750k
$1M-1.5M
$1.5M-2M
$2M-Above
Other Primary Ductless Brand:
What percentage of your business is Ductless Equipment?
(Required)
0 - 20%
21 - 40%
41 - 60%
61 - 80%
81 - 100%
What percentage of your business is Light Commercial RTU's?
(Required)
0 - 21%
21 - 40%
41 - 60%
61 - 80%
81 - 100%
What percentage of your business is Unitary Equipment?
(Required)
0 - 20%
21 - 40%
41 - 60%
61 - 80%
81 - 100%
Phone
This field is for validation purposes and should be left unchanged.
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