Distributor & Reseller Program Thank you for your interest in stocking Inspired LED products. Please complete all sections below.Questions? Call (480) 941-4286 or email orders@inspiredled.com 1. Primary Contact Today's Date Contact Name Job Title Direct Phone Email Address 2. Company Information Legal Company Name DBA / Trade Name (if different) Date Established Type of Organization Company Website Primary Business Email Main Phone Headquarters / Main Branch Address City State ZIP No. Of Branch Locations States Where Branches Operate 3. Tax & Compliance Federal EIN (Employee Identification No. State Tax-Exempt / Resale Certificate No. Issuing State Accounts Payable Contact Name A/P Email A/P Phone Billing Address (if different) 4. Distribution Profile Type of Organization Sole Proprietor LLC S-Corp C-Corp Partnership Cooperative Customer Segments Served Electrical Contractors General Contractors Industrial / MRO Residential Commercial / Retail Government Other Total Number of Employees Geographical Coverage (All States/Regions Servied) No. Of Outside Sales Reps No. Of Inside Sales/ Counter Staff 5. Purchasing & Sales Projections Total Annual Sales Volume ($) Annual LED / Light Sales ($) Est. Annual Inspired LED Purchases ($) Est. Monthly Order Frequency Average Order Size ($) Preferred Order Method Select...OnlinePhoneEmailEDI Current Primary LED / Lighting Suppliers 6. Stocking & Inventory Capabilities Dedicated Warehouse / Stock Space Available? Select...YesNo Approx. Sq. Ft. For Lighting Products / SKUs you Intend to Stock Existing Showroom or Display Area? (Describe) Describe your sales strategy for promoting and selling Inspired LED products, your target customer base, and your level of fommitment to our product line 8. Trade References Reference 1 - Company Name Contact Name Phone Email Reference 2 - Company Name Contact Name Phone Email 9. Certification & Signature Certification and Signature By submitting this form, I certify that all information provided is accurate and complete. I understand that Inspired LED reserves the right to verify all information and that approval as an authorized distributor is at the sole discretion of Inspired LED.