Enrollment Form
Please submit the information below to apply for enrollment in the DuraSeal® Pro Rewards Program. This program is for Professional Hardwood Floor Installers, Refinishers or Contractors Only. Not open to the general public or owners or employees of hardwood floor product retailers.
Personal Information & Rewards Mailing Address
NOTE: The address you enter is where your rewards will be delivered. Please enter your complete mailing address to avoid delays in processing and delivery
First Name*
Last Name*
Company Name*
Business Address*
City*
State*
Zip*
Phone*
DOB*
Account Information
Note: Please use your work email. This will be your program Username. Passwords must be at least 8 characters long and contain at least one letter and one number. Passwords should not contain any special characters.
Email Address* - your email address will be your Username
Confirm your Email Address*
Password* - this will be your rewards program password
Confirm Password*
True False False False
Retailer Details
Store ID*
Store Name*
Address*
City*
State*
Postal Code*
Questionnaire
To participate in the program you must read and agree to the following:
Check below if you would like to receive product information, special offers & promotions outside of this program, from our other applicator brands: