Buyer Registration Forms

Omega Environmental Technologies is exclusively a business-to-business company. To become a Registered Member and gain access to Omega's line of mobile air conditioner parts, components and systems for all types of vehicles, please complete the form below, completing all fields and answering all questions.

Once your registration is submitted, you'll be sent an e-mail response. One of our Sales Representatives will contact you within 24 hours or the next business day to complete the registration process.

First Name

Last Name

Company

 

Street Address

Suite or Apt. #

City

State or Province

Country

Zip or Postal Code

Phone

Email

Please tell us about yourself:

 I am a current Omega customer.

 I am a retail customer.

 I certify that I own or am a buyer for an auto parts distributor and/or retailer.

 I certify that I am a fleet manager.

 Other

Other Other:

How did you hear about us? ---------------------------- Referral Search Engine Magazine Trade Show

Which Magazine

Capthca

Submit