HeatShield Installer Application

SaverSystems offers training to qualified chimney professionals. Acceptance for training is based on industry experience, education, certifications, peer references and course availability. Currently, our one day training qualifies for 6 CEU credits for both CSIA and NFI certifications. When you have successfully completed our training course you will be eligible to purchase the HeatShield Cerfractory Flue Sealant and Repair System on a non-exclusive basis, provided you continue to meet the requirements below. The HeatShield products and supplies are available factory direct or through National Chimney Supply. There are no franchise fees, exclusive or protected territories or purchase minimums.

HeatShield Installer Requirements:
In order for you to receive maximum benefit from this opportunity, you must be involved in the daily cleaning, inspection, repair, and relining of masonry chimneys and meet the following criteria:

Certifications from one or more nationally recognized education and certification organizations.
Membership in the NCSG and/or HPBA with strict adherence to the published “Code ofEthics”.
Your company must currently offer Level II inspections per NFPA 211.
You must complete the HeatShield Installer factory training course.

Please tell us about yourself:

Installer Application

Name*
First Last
Company Name*
Company Name
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Shipping Address Same as Billing?*
- Yes
- No
Shipping Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Company Phone
Cell Phone
Fax
Email
Which distributor, if any, referred you?
Years in business?
Approximately how many chimneys does your company service each year?
How many trucks does your company operate?
What certifications do you have? Please list the certification, the certification#, and how many years held.
What additional industry educational opportunities have you attended?
In what industry guilds or associations are you a member of in good standing? Please list how many years held for each.
Does your company currently offer:*
- Masonry repairs
- Stainless steel relining
- Cast-in-place systems
- ThermoCrete Ceramic Flue Sealant
- Smoke Tight smoke chamber repair
- FireGard mortar joint repair
Do you regularly sweep and video scan?*
- Yes
- No
Approximately how many stainless steel relines do you do per year?
Which cast-in-place system do you use?
Approximately how many ThermoCrete jobs do you do per year?
Approximately how many Smoke Tite jobs do you do per year?
Approximately how many Firegard jobs do you do per year?
Do you currently offer Level II inspections per NFPA 211?*
- Yes
- No
Is your company fully insured?*
- Yes
- No
Please have agent fax proof of insurance to 765-935-4999. Upon acceptance to training you will be required to list SaverSystems to policy.
What percentage of chimneys in your market are suitable candidates for this type of repair system?
Why do you think the HeatShield Flue Sealant Repair System would be good for your business?
Peer References (Other Chimney Professionals)
Peer Reference #1
Name
First Last
Phone
Number of years known
Peer Reference #2
Name
First Last
Phone
Number of years known
Peer Reference #3
Name
First Last
Phone
Number of years known
Applicant Statement*
- I certify that all information I have provided on this application is true, complete and correct.
- I understand that any information provided by me that is found to be false, incomplete or misrepresented inany respect, will be sufficient cause to (i) cancel further considerationof this application, or (ii) immediatelydischarge me from the rights to purchase goods and services from SaverSystems, whenever it is discovered.
- I understand that if my company goes 18 months or more without purchasing HeatShield Cerfractory FlueSealant, our status as an authorized HeatShield dealer will become inactive and we will be unable topurchase HeatShield Cerfractory Flue Sealant from SaverSystems or an authorized distributor. Toreactivate, I will need to complete a HeatShield training test available at www.heatshieldpro.com/test witha passing score of 80% or higher.
- I expressly authorize, without reservation, SaverSystems, LLC (dba SaverSystems), its representatives,employees or agents to contact and obtain information from all references, public agencies, licensing,certification authorities and educational institutions and to otherwise verify the accuracy of all informationprovided by me in this application. I hereby waive any and all rights and claims I may have regarding theemployer, its agents, employees or representatives, for seeking, gathering and using such information in theapplication/approval of the “Approved HeatShield Installer” process and all other persons, corporations ororganizations for furnishing such information about me.
- I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.
Please type your name below as your signature to confirm that you accept the terms of the applicant statement.*
Date of Acceptance
MM slash DD slash YYYY
Name
First Last
Email
This field is for validation purposes and should be left unchanged.

HeatShield Installer Application

Installer Application

Peer References (Other Chimney Professionals)

Peer Reference #1

Peer Reference #2

Peer Reference #3