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Application Process:


Please read the Dealer Requirements before completing the application.

Complete your application in 3 easy steps:

  1. Download the application form (you will need a password - complete the form below to apply for a password)
  2. Complete the form and fax to us at 678-550-9876
  3. Wait to receive your login information, which will be e-mailed to you.


Password Request Form:

To receive your password to enable you to download the Application form, you will need to complete the following information and submit to Xtreme Heaters.


*Asterisk denotes a required field

Company Name *


Work Phone *


Your Full Name *


Mobile Phone


Email Address *




Comment / Inquiry


Company Website





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