Wayne Enterprises | American Standard User Account Request Form

Name * Required Field		Location * Required Field
Company * Required Field
Are you a Dealer or Distributor? Dealer Distributor * Required Field
If you are a Dealer, who is your Distributor? * Required Field
Are you a Customer Care Dealer? Yes No * Required Field
Email Address * Required Field		Phone Number * Required Field
Shipping Address Line 1 * Required Field
Shipping Address Line 2
City * Required Field	State * Required Field		Zip Code * Required Field

For problems or questions regarding the functionality of this request form, please contact us by phone at (800) 749-0947 or by email at points@wayne-ent.com.