Updated Tech Service Residential Start Up Sheet

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Are you contacting us as a...*
- Contractor
- Vendor
- Facility Owner/Manager
- Property Developer
What type of request do you have?*
Are you a current HVAC Distributors Customer?*
If you're a current HVAC Distributors customer, you'll be asked for your account ID to more quickly route your request to the appropriate location.
- Yes
- No
HVAC Distributors Customer Number
Your HVAC Distributors Customer Number ("Eclipse ID" or "Dealer Number"), if known. Leave this field blank if you don't know your customer number.
Company Name*
Contact Name*
First Last
Contact Email*
Address*
HVAC Distributors is a wholesale distributor serving Pennsylvania, New York, Delaware, Maryland, and Virginia. We are unable to provide equipment, parts, or referrals outside our service area.

Street Address Address Line 2 City State ZIP Code
Business Location*
HVAC Distributors is a wholesale distributor serving Pennsylvania, New York, Delaware, Maryland, and Virginia. We are unable to provide equipment, parts, or referrals outside our service area.

City State ZIP Code
Phone*
Phone Extension
Is your request related to a current claim?*
- Yes
- No
Warranty Claim Number*
Your Claim Number from HVAC Distributors' Warranty Portal
Is your request related to a warranty contract?*
- Yes
- No
Order Number for Follow Up*
This number will start with an "S"
What can we help you with?*
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Phone: 717-928-2118 Fax: 717-939-9723 Toll-Free: 1-800-689-4822

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Name*
First Last
Your Email:*
Are you a current HVAC Distributors customer?*
- Yes
- No
HVAC Customer ID*

Also known as "Eclipse ID"
Company Name*
Address*
Street Address Address Line 2 City State ZIP Code
Primary HVAC Business Area*
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