PROVENTIA FILTERS - INFORMATION REQUEST FORM   Thank you for your interest in our CARB-VERFIED filters, offering you the LOWEST-COST, best-engineered compliance solutions for your Thermo King and Carrier reefers. Please let us know what information you'd like to receive. (* Indicates field is required.) Questions? Call Victoria 9am-5pm (PT) toll-free at 800-609-7686, direct at 612-483-1822, or visit us online at www.proventiafilters.com. ______________________________________________________________________________________________________________ SAVE UP TO $250 off every 2003 TRAILER FILTER!   No limit on quantity.   Limited time only -- ACT NOW for the greatest savings.   Check here if you'd like more information. ______________________________________________________________________________________________________________ First Name* Last Name* Title Company Name* Email Address* Phone Number* Address City State* Select --- US States --- AL - Alabama AK - Alaska AZ - Arizona AR - Arkansas CA - California CO - Colorado CT - Connecticut DE - Delaware FL - Florida GA - Georgia HI - Hawaii ID - Idaho IL - Illinois IN - Indiana IA - Iowa KS - Kansas KY - Kentucky LA - Louisiana ME - Maine MD - Maryland MA - Massachusetts MI - Michigan MN - Minnesota MS - Mississippi MO - Missouri MT - Montana NE - Nebraska NV - Nevada NH - New Hampshire NJ - New Jersey NM - New Mexico NY - New York NC - North Carolina ND - North Dakota OH - Ohio OK - Oklahoma OR - Oregon PA - Pennsylvania RI - Rhode Island SC - South Carolina SD - South Dakota TN - Tennessee TX - Texas UT - Utah VT - Vermont VA - Virginia WA - Washington Washington DC - District Of Columbia WV - West Virginia WI - Wisconsin WY - Wyoming Armed Forces Americas Armed Forces Pacific Armed Forces other American Samoa Guam Northern Mariana Islands Palau Virgin Islands --- UK Counties --- Avon Bedfordshire Berkshire Buckinghamshire Cambridgeshire Cheshire Cleveland Cornwall Cumbria Derbyshire Devon Dorset Durham Essex Gloucestershire Hampshire Hereford & Worcester Hertfordshire Humberside Kent Lancashire Leicestershire Lincolnshire London Manchester Merseyside Norfolk Northamptonshire Northumberland Nottinghamshire Oxfordshire Shropshire Somerset Staffordshire Suffolk Surrey Sussex Tyne & Wear Warwickshire West Midlands Wiltshire Yorkshire --- Canadian Provinces --- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory --- Australian States and Territories --- Ashmore and Cartier Islands Australian Capital Territory Coral Sea Islands Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia --- New Zealand Regions --- Auckland Bay of Plenty Canterbury East Cape Hawke's Bay Manawatu-Wanganui Marlborough Nelson Northland Otago Southland Tasman Waikato Wellington West Coast --- Hong Kong Administrative Districts --- Central and Western Eastern Islands Kowloon City Kwai Tsing Kwun Tong North Sai Kung Sha Tin Sham Shui Po Southern Tai Po Tsuen Wan Tuen Mun Yuen Long Wan Chai Wong Tai Sin Yau Tsim Mong ZIP or Postal Code Country (if not USA) How did you hear about us? (check all that apply)* CARB Website CARB Presentation or Webinar CARB Advisory Magazine Ad Email from Proventia Internet Search (Google, Yahoo, etc.) Friend or Colleague (please specify) Other (please specify) Who was the friend or colleague who told you about us? What "other" way did you hear about us? What CARB-Verified filters would you like information about? (check all that apply)* 2003 Thermo King TRAILER    (Save up to $250 per filter!) 2003 Carrier TRAILER    (Save up to $250 per filter!) 2003 Thermo King Truck/BOBTAIL 2003 & older CARRIER Truck/BOBTAIL (Available FALL 2010) 2002 & older Thermo King TRAILER 2002 & older Carrier TRAILER 2002 & older Thermo King Truck/BOBTAIL CHILI (Availble Winter 2011) 2007-2009 Thermo King TriPac APU (Available Winter 2011) Other Filter (please specify) What "other" kinds of filters are you interested in? (Please include year, make, and model.) About how many 2003 Thermo King TRAILER filters do you need?   (save up to $250 on each filter!) About how many 2003 CARRIER TRAILER Filters do you need?   (save up to $250 on each filter!) About how many 2003 Thermo King TRUCK (BOBTAIL) filters do you need? (Note: These filters are not eligible for the Coupon Program.) About how many 2003 CARRIER TRUCK (BOBTAIL) filters do you need? (Note: These filters are not eligible for the Coupon Program.) About how many 2002 or older Thermo King TRAILER filters do you need? (Note: These filters are not eligible for the Coupon Program.) About how many 2002 or older Thermo King TRUCK (BOBTAIL) filters do you need? About how many 2002 or older CARRIER TRUCK (BOBTAIL) filters do you need? About how many Thermo King TriPac filters do you need? Are you interested in becoming a dealer? (requirements apply) Yes No How else can we help? Thank you! You'll receive the information you've requested at the email address you provided above. (Please make sure you've entered your email address correctly, before submitting your request.) If you don't receive the information you've requested within 4-6 hours, please check your junk mailbox. If our email isn't there, be sure to add proventiafilters@gmail.com to your "safe senders" list, and then email us at proventiafilters@gmail.com with "RESEND INFO" in the subject line. Thanks again for your interest in PROVENTIA CARB-VERIFIED FILTERS -- the LOWEST-COST compliance solution AVAILABLE for your Thermo King & Carrier reefers.   * Indicates field is required.