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Catalog Request Form

Company Name*
Are you an HVAC Distributors customer?*
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HVAC Distributors ID*
Also called "Dealer Number" or "Eclipse ID"
Address*
City*
State*
ZIP Code*
Contact Name*
First Last
Contact Email*
Phone*
Extension
Quantity (each)*
Delivery Options*
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What type of request do you have?*
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*
Please use the location where we address your invoices

City State ZIP Code
Phone*
Phone Extension
Is your request related to a current claim?*
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Warranty Claim Number*
Your Claim Number from HVAC Distributors' Warranty Portal
Is your request related to a warranty contract?*
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Order Number for Follow Up*
This number will start with an "S"
What can we help you with?*
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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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