Fill Out This Form

Thank you, your information has been received! Please allow 5-7 business days for processing. All submissions are subject to approval.x

* Required

Company Name *

First Name *

Last Name *

E-mail address *

Telephone Number *

Address *

City *

State *

Zip Code *

Federal Tax ID #

Company Type

Company Website URL?

Where is the majority of your business conducted?

Please provide links for any social media accounts you currently use to promote your business.

What is your business' primary product or service?

Do you currently sell refrigerators? If "Yes", what other brands do you sell?

In what state or states do you currently do business?

Additional information you would like to provide us about your business.

Thank you for your interest in becoming an authorized Superior Propane LP Gas Refrigerators Dealer.

Superior: Dealer Request Form