To request access to your account via Dometic's Secure Web Site, please complete the following form, and Fax it to us at (260) 572-2200.
You will be contacted within 2 business days concerning your request.
________________________________________
Company Name
(required)
_______________________________________
Dometic Account Number
(required)
_______________________________________
Address
(required)
_______________________________________
Phone
(required)
_______________________________________
Address
_______________________________________
Fax
(required)
_______________________________________
City,
State,
Zip
(required)
_______________________________________
Primary User's Name
(required)
_______________________________________
*Primary User's email address
(required)
(for online confirmations and Password notification)
OPTIONAL
:
While having a single USERID per account is sufficient in many cases, if you would prefer Unique USERIDs for each individual user, please list additional users here. Access will include the ability to view account history as well as initiate new activity. In the event that one of the employees listed leaves your company, it is your responsibility to notify us immediately so that we can disable their account.
Name(s):
email address
:
(
for Password notification only -
all other correspondence sent to primary account above)
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
OPTIONAL
(Customers Only)
Our Dealers/Service Centers are automatically listed on some of our web sites. If you do not wish to have a complete listing shown, please check one of the following:
__ Do not show our
address
on Dealer Locator (OK to list Phone/FAX/email)
__ Do not list our business on any of Dometic's websites
I hereby authorize the above named people to access our Dometic account information online:
_______________________________________
*Authorized By
_______________________________________
*Authorized Signature
*
Must have a signature and a valid email address to set up your account