Refrigerant Certification – Statement in Lieu of License

You can complete the form below, print it, sign it, and return it to Chiller City by eBay message, email, or text. If you prefer a PDF, you can still download it using the link below.

Return to online verification page

In addition to the online form we can also accept your certification that you may legally receive refrigerant.

If you have a refrigeration license:
You can simply take a picture/scan it and send it to us by eBay messaging, email, or text.

If you do NOT have a refrigeration license:
Download the PDF form here or complete the form below.

eBay: coldstuff2000
Text: 480-889-1092
Email: andy(at)chillercity.com

Only the section below will print.

Statement in lieu of refrigeration license

I hereby certify that the R-22 refrigerant that I am purchasing is being purchased solely for resale to or installation by an EPA-certified technician. I certify that I will comply with all applicable laws and that I am legally permitted to purchase, accept delivery of, possess, and resell R-22 refrigerant.


Name:

Address:

City:	State:	ZIP:

Date:

eBay User ID:

Signature:

Fill out above and return