*Company Name: Dealer Account #:
*Address: *City: *State: *Zip:
*Contact Name: *Phone #: Fax #:
*E-mail Address:
* Indicates REQUIRED field.
Student #1:
First Name: Last Name:
E-mail Address:
Class: Date:
Class Location:
Are you a registered user of our LMS? Yes No
Student #2:
Student #3:
Student #4:
Bill My Lennox Dealer Account Use DLPD Credit Credit Card For credit card payment call 800.654.3283, Option 2
Dealer Acct#: Check here if you are a Premier Dealer.
Important Information
**Special Note for 12(S) U.S. Refrigerant Recovery Class ONLY** The course text will be sent to students in advance, and should be studied prior to taking the class. If registration is received less than 7 days prior to the class, the dealer is responsible for the cost of shipping the text via Next Day or Second Day UPS.
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