CO-OP CLAIM REQUEST Please enable JavaScript in your browser to complete this form.InformationDistributor Name *Address *Address Line 1Address Line 2CitySelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSubmitted By *FirstLastContact Email *Contact Phone *Date of Claim Creation *This is today’s date.PromotionPromotion Type: *SelectBillboardChachkiDealer IncentiveDealer MeetingDealer RecruitmentDirect MailDistributor MeetingLiteratureMagazineNoveltiesOpen HouseOtherRadioSignageSponsorshipTrainingUniformsVehicle DecalsChoice 19Select the literature you need: *Ductless Mini SplitsHeat Pump Condensing UnitsAir Conditioner Condensing UnitsAir HandlersGas FurnacesPackaged UnitsIndoor Coils13 to 16 SEER Split Systems – Consumer Brochure16 to 20 SEER Split Systems – Consumer Brochure14 to 16 SEER Packaged Systems – Consumer BrochureVariable and Fixed Speed Air Handlers – Consumer BrochureQTY – Ductless Mini Split Literature *QTY – Heat Pump Literature *QTY – Air Conditioner Literature *QTY – Air Handler Literature *QTY – Gas Furnace Literature *QTY – Packaged Units Literature *QTY – Indoor Coils Literature *QTY – 13 to 16 SEER Split Systems Consumer Brochure *QTY – 16 to 20 SEER Split Systems Consumer Brochure *QTY – 14 to 16 SEER Packaged Units Consumer Brochure *QTY – Variable and Fixed Speed Air Handlers Consumer Brochure *Promotion Date *Promotion Description *Promotion Cost *Claim Amount Requested *File Upload *Upload any receipts or purchase orders associated with this claim.WebsiteSubmit
