The following are the names and certificate data for our employees who possess a valid EPA refrigerant certificate:
The following are the names of the persons authorized to pick up refrigerant, representing one or more of the certified technicians above:
Please upload, fax, or mail a copy of each technician's certification card and driver's license for proper identification. Any change in the status of the above named certificate holders and additions or deletions to the list are the responsibility of the undersigned.
By submitting this form, you agree that this will serve as your electronic signature. If you do not agree, you will need to fill out a form in person at one of our locations.