Raypak, Inc. Authorized Dealer Website Disclosure Form

Raypak, Inc. Authorized Dealer Website Disclosure Form

If you wish to sell Online Eligible Products (as defined in the Raypak, Inc. Authorized Dealer Policy for the United States, hereafter “Dealer Policy”) on your own proprietary website, you must disclose your website using this form.

This Form is only used to register “Permissible Public Websites,” as defined in the Dealer Policy. You are prohibited from selling Online Eligible Products on online marketplaces (such as Amazon, eBay, and Walmart Marketplace). Consent to sell Online Eligible Products on online marketplaces is not granted through this form.

You continue to be prohibited from selling all products on the Ineligible for Online Sales List available at https://www.raypak.com/internetpolicy/ online.

This website disclosure process and the Dealer Policy are applicable only in the United States of America. You are responsible for keeping all information up to date with Raypak, Inc.

* Fields marked with an asterisk are required.

Company Information:

Company's Legal Name*

Company’s DBA/Trade Names (if any)*

Company Address

Company Address 2

Company City

Company State

Select

Company Zip Code

(Please include only 5 digits)

Company Email Address

Company Phone Number

Example: (###) ###-####

Primary Contact:

Full Name**

Position at Company*

Email Address**

Phone Number*

Example: (###) ###-####

1. Please identify the URL for each website where you sell or intend to sell the Online Eligible Products.*

Please review the restrictions on online sales in the Dealer Policy carefully. Please note that you are only permitted to sell the Online Eligible Products on Permissible Public Websites (i.e., a website operated in your legal name or registered fictitious name). Consent to sell Online Eligible Products on online marketplaces is not granted through this website disclosure process.

Further, please note that you are required to abide by all Low NOx (nitrogen oxide) restrictions which may apply in some geographic regions (e.g., certain states, counties, or communities). Please do not ship non-Low NOx products to those geographic regions. This restriction is also applicable to E3T electric pool heaters.

If applicable, from which Authorized Distributor(s) do you purchase Raypak branded products?

Select

By checking this box, I agree, on behalf of Dealer, as follows:

1. Dealer will abide by the Raypak, Inc. Authorized Dealer Policy for the United States, including by not selling non-Low NOx products into geographic regions requiring Low NOx products through its Permissible Public Website and any E3T electric pool heater restrictions.

2. Dealer affirms that the information provided in this Form is true, accurate, and current.

To submit please check this box to confirm and acknowledge the above contents.*

Send me a copy of my responses

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