Buyer Registration Forms

Omega Environmental Technologies is exclusively a business-to-business company. To become a Registered Member and gain access to Omega's line of mobile air conditioner parts, components and systems for all types of vehicles, please complete the form below, completing all fields and answering all questions.

Once your registration is submitted, you'll be sent an e-mail response. One of our Sales Representatives will contact you within 24 hours or the next business day to complete the registration process.

First Name*:
Last Name*:
Street Address*:
Suite or Apt. #:
State or Province*:
Zip or Postal Code*:
Telephone Number*:

Please tell us about yourself.

How did you hear about us?

If you selected magazine, please tell us which one: