Contractor Enrollment

Be sure to click submit when all fields are completed.

Enrollment Form

Company Name

Address

Accounts Payable

Distributor

Documents

User Info

Review & Submit

What is the name of your company?

Where is your company located?

Manual Entry Mode

Toggle to manually enter address information instead of using Google Places search

Company Address

Address*

Apt/Suite (optional)

Reminder: If your business has a suite, unit, or apartment number, please add it above.

City*

Province*

Postal Code*

Country*

Account Payable

Accounts Payable Contact*

Accounts Payable Telephone*

Accounts Payable Email*

#GST*

#HST*

#QST*

Please provide the required business documents.

Certificate of Insurance (COI)*

Drop files here or click to upload

PDF, DOC, or DOCX files only

W-9 Form*

Drop files here or click to upload

PDF, DOC, or DOCX files only

Florida 2-52 Form*

Drop files here or click to upload

PDF, DOC, or DOCX files only

Select Your Primary Distributor

Can't Find Your Distributor?

You can manually enter your distributor using the "Add My Distributor" button.

Custom Distributor Added

Distributor details go here.

SEARCH FROM LOCATION

Company address

Custom ZIP/Postal

SEARCH RADIUS

50 miles

Name	Address	Postal	Distance

No distributors were found in your area. You can add your own distributor using the "Add My Distributor" link above.

Please enter your user information.

First Name*

Last Name*

Email*

Phone*

Title

Security question

Security answer

Review your enrollment information and submit below.

Signature*

I have read and agree to the terms and conditions specified here

page_ContractorEnrollment_Button_Submittng

Enrollment Submitted

Thank you for enrolling. Our team will review your submission and contact you within 1 business day. If you need assistance, please reference your Temp ID when contacting Prime Warranty.

Temp ID:

Submitting your enrollment…

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Potential Duplicate Company

We found companies similar to yours near this address.

Name	City	State	Phone	Source

Edit the information you entered.

Add My Distributor

Manual Entry Mode

Toggle to manually enter distributor information instead of using Google Places search

Search for establishment

Use Google Places to find and auto-populate distributor details

Distributor Name *

Address

City

State/Province

Postal Code *

Country

Duplicate Distributor Found

A distributor with this name and postal code already exists. Would you like to select this existing distributor instead?

A distributor with this name and postal code already exists. Would you like to select this existing distributor instead?

Replace Custom Distributor?

You have already selected a custom distributor. Selecting a distributor from the list will replace your custom selection. Are you sure you want to continue?

Confirm Address

We found a standardized address. Please choose which one to use: