Authorized Contractor Program Application

Thank you for your interest in the Ultravation Authorized Contractor program

Please complete the online form below to submit your application for Ultravation Authorized Contractor status. Please note that it may take up to 2 weeks for authorization.

Fields marked with a red asterisk* are required! Please also check that your "caps lock" is off so that the application is not completed in all capital letters.

"*" indicates required fields

Company Name*

Your Name*

Title*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Enter Email Confirm Email

Website

About your business

Years in Business*

Please describe your company*

What do you currently sell

UV Equipment

Media Air Cleaners

Other types of air purifiers, cleaners and IAQ products

Approximate percentage of your business

Residential %

Please enter a number from 0 to 100.

Commercial %

Please enter a number from 0 to 100.

Wholesalers where you currently purchase the above products

Preferred Wholesaler*

Location

Alternate Wholesaler 1

Location

Alternate Wholesaler 2

Location

reCatpcha

Name

This field is for validation purposes and should be left unchanged.