Section 1: Contractor / Submitter Information Full Name *
Company *
Job Role * Select an option Business Owner / Principal Service Manager Lead / Senior Technician Installer / Technician Apprentice End User
Title
Product/Solution of Interest
Business Phone *
Email Address *
Years in HVAC industry (optional)
Section 2: Shipping Address (for Reward Fulfillment) Note: "Shipments to AK, HI, PR, GU, and U.S. territories are not eligible per promotion T&Cs."
Address 2
City *
State or Province * Select an option Alaska Alabama Arkansas American Samoa Arizona California Colorado Connecticut D.C. Delaware Florida Micronesia Georgia Guam Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Marshall Islands Michigan Minnesota Missouri Marianas Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Palau Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming Military Americas Military Europe/ME/Canada Military Pacific Alberta Manitoba British Columbia New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
Country Select an option United States Canada Brazil Mexico EU United Kingdom India Netherlands Australia South Africa France Germany Singapore Sweden Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil Brit/Indian Ocean Terr. Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, The Dem. Republic Of Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Terr. Gabon Gambia Georgia Germany Ghana Gibraltar United Kingdom Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard/McDonald Isls. Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea (North) Korea (South) Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar N. Mariana Isls. Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Samoa San Marino Sao Tome/Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovak Republic Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka St. Helena St. Pierre and Miquelon St. Vincent and Grenadines Sudan Suriname Svalbard/Jan Mayen Isls. Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks/Caicos Isls. Tuvalu Uganda Ukraine United Arab Emirates United States US Minor Outlying Is. Uruguay Uzbekistan Vanuatu Vatican City Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis/Futuna Isls. Western Sahara Yemen Zambia Zimbabwe
Zip *
Section 3: Distributor / Purchase Information Authorized Distributor Name *
Distributor Branch Location (City, State) *
Branch Sales Rep Name (optional)
Invoice Number(s) (Divide entries by commas) *
Invoice Date(s) (Must fall within 7/1/2026 – 8/14/2026)
Section 4: Tier Selection Select the tier that matches your total qualifying pump purchase. Malco will verify eligibility with submitted proof of purchase.
Contractor selects the tier they're claiming: *
Section 5: Proof of Purchase Upload the purchase documentation Malco needs to verify the selected reward tier.
Section 6: Certifications & Agreements (checkboxes, all required) I certify the products purchased from an authorized U.S. wholesale distributor within the US. * I certify these products have not been returned, canceled, credited, or refunded. * I am not an unauthorized reseller, freight forwarder, or export intermediary. * I understand promotional items are fulfilled directly by The Malco Group, may ship separately. * I have read and agree to the full Promotion Terms & Conditions * Opt-in: I agree to receive marketing communications from The Malco Group and its portfolio brands. 
