Contractor & Electrician Discount Program Trade Professional Application Complete this application in its entirety. Approved applicants receive trade discount pricing.Questions? Call (480) 941-4286 or email orders@inspiredled.com 1. Applicant Information Today's Date mm/dd/yy Applicant Full Name Job Title / Role Phone Number Email Address 2. Business Information Legal Business Name DBA (If Different) Date Business Established e.g.2010 Years In Business Business Website Business Email Address Business Phone Fax (If Applicable) Business Street Address City State Zip 3. Tax & Licensing Information Federal EIN XX-XXXXXXX State Tax-Exempt / Resale Certificate No. Issuing State Contractor License Number (If Applicable) Electrical License Number (If Applicable) License Issuing State License Expiration Date Resale Certificate and/or Applicable Contractor or Electrical License(Required) Max. file size: 50 MB. 4. Trade Credentials & Business Type Primary Trade Type General Contractor Electrical Contractor Electrician (Independent) Lighting Specialist Other Type of Organization Sole Proprietor LLC S-Corp C-Corp Partnership Primarily Work On Residential Commercial Industrial Government / Municipal Mixed Number of Employees / Field Technicians Primary Service States / Coverage Area Projects Completed (Last 12 Mo.) Avg. Project Size ($) 5. Projected LED / Lighting Purchases Estimated Annual LED Spend ($) Current Primary Supplier(s) Est. Monthly Unit Volume Avg. Order Value ($) 6. Target Markets & Top Customer Types Top Customer Type 1 Top Customer Type 2 Top Customer Type 3 Geographic Regions Served 7. Business Overview Briefly describe your business, the types of projects you install LED lighting on, and why you are interested in becoming an Inspired LED trade account. 8. Certification & Signature Authorized Signature (Type Full Name) By signing below, I certify that all information provided is accurate and that my business qualifies as a licensed trade professional or contractor. I understand that Inspired LED reserves the right to verify all information and revoke trade pricing if eligibility requirements are not met. Date Printed Name Title
