BECOME A DEALER FORM

Please fill out and submit the form below to join the 5-2-1 Compressor Saver Dealer Network!

    Section A: Contact information for Dealer Locator

    To be published on the five-two-one website as part of the Dealer Locator Tool – homeowners will contact your company using this information.

    Section B: Contact information for 5-2-1 Dealer Program

    (for internal CPS use only)

    Used to process/validate rebate submission data and corresponding promo code retrieval)

    Section C: Please select your answer to the following questions:

     YesNo  YesNo  YesNo  Less than 500500 to 1,0001,000 to 3,000more than 3,000None  YesNo  Less than 100500 to 1,0001,000 to 3,000more than 3,000None  YesNo