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Application For Participation In The On-Line Contractor Locator Service

Thank you for your interest in the Weil-McLain on-line contractor locator service. Our goal is to help consumers identify experienced Weil-McLain hydronic experts in their area, and provide qualified leads to our contractor partners. Applications will be evaluated for overall hydronic experience, Weil-McLain training, and business location. All information will be kept confidential. By completing this application you agree to provide updated information semi-annually, and understand that failure to comply may result in removal from the database. Completing and submitting this application does not necessarily guarantee inclusion in the Weil-McLain on-line contractor locator service.

Please read this application carefully and complete all questions. To complete the application process you must fax or forward a copy of your liability insurance certificate and state license, if applicable to: Weil-McLain, Contractor Locator Service, 500 Blaine St., Michigan City, IN 46360, or fax to: (219) 877-0556

Enter the code as it is shown (required):

First Name: * Initial: Last Name: *

Title:

Company Name: * Company Address: *

Company City: Company State: Company Zip:

Company Phone Number: Company Fax Number:

Primary business type (i.e., plumbing, HVAC contractor)

How many years has the above company been in business? A value is required.Invalid format.*

How many service technicians do you employ? A value is required.* How many installers? A value is required.*

Do you provide commercial boiler start-up service? Yes No

What is your plumber or contractor license number (if state required)?

Do you have liability insurance? Yes No

Do you offer 24-hour emergency service? Yes No

Which fuel types do you service (check all that apply):
Gas-fired equipment Oil-fired equipment Propane-fired equipment

Which types of services do you provide (check all that apply):

Boiler Installation:
Residential steam boiler installs	Residential hot water boiler installs
Commercial steam boiler installs	Commercial hot water boiler installs
Boiler Service:
Residential steam boiler service	Residential hot water boiler service
Commercial steam boiler service	Commercial hot water boiler service
Other Installations:
Radiant heat installs	Multiple boiler system installs
Snow melt system installs	Indirect fired water heater installs

Approximately how many Weil-McLain boilers do you install each year?

Please indicate which type(s) of testing equipment you own (check all that apply):
Oxygen Carbon Monoxide Carbon Dioxide Smoke Draft

How many hydronic heating training classes have you attended in the prior three years?

How many Weil-McLain training classes have you attended in the prior three years?

Do you have any NATE certifications (please list)?	Do you have any other certifications (please list)?
I certify that all statements are true and correct. Yes *	Email Address: