Dealer Application

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Customer warrants that the following information is accuate and complete. For questions regarding our application to become a Lifetime LED dealer email orders@lifetimeledlights.com

Business Name *

Business website address

Tax ID # *

Mailing Address *

Example - 2222 Main Street, Your City, State, Zip

Shipping Address (if different than above)

Contact Person - First and Last name *

Phone Number *

Fax Number (optional)

Formed/Incorporated under the state laws of: *

Date of formation *

Month

Day

Year

Length of time of present ownership: *

Years and Months

*All account are pre-pay, no terms or credit extended, no exceptions *

I agree to the terms on your dealer application

I do not agree to the terms

Email Address *

Contact email address

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Dealer Application

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Text Us 585-203-0887