Create a Wholesale Account

All fields are required (unless otherwise noted)

To qualify for our dealer/wholesale program you must submit:

A valid Reseller Permit
Contractor's License

Please email jeremy@truaqua.com or fax a copy to 714-256-8300 after you have submitted your dealer application online.
We will contact you within two business days about your application.

Login Information

*First Name:

*Last Name:

*Email Address: (This will be your username.)

*Password:

*Password: (verify)

Receive Special Offers from truAQUA.com

Shipping Information

*First Name:

*Last Name:

Company Name:

*Street Address:

Suite or Apt # or any additional information:

*City:

*State:

*ZIP or Postal Code:

*Country:

*Shipping Phone:

Fax:

Billing Information

Check box if same as shipping information

*First Name:

*Last Name:

Company Name:

*Street Address:

Suite or Apt # or any additional information:

*City:

*State:

*ZIP or Postal Code:

*Country:

*Billing Phone:

Fax:

Additional Information

Reseller Tax Id:

Comments

Comments: