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NEW ACCOUNT SETUP

Yes, WE LOVE TO BUILD LONG-TERM PARTNERSHIPS AND DISCOVER HOW TO SERVE YOU BEST.

New Account Application

Your Contact Information

Full Name
Title
E-mail Address
Phone Number

Bill To Information

Company Name
Street Address Line 1
Street Address Line 2
City
State
Zip Code
Phone Number
Fax Number
Federal Tax ID/EIN
Business Type
Website
Number of Locations
Years in Business

PO RequiredYesNo

E-Mail Invoices YesNo

Tax ExemptYesNo

If yes, please provide us with copies of Resale Certificate, Tax Exemption Certificate, and signed W9 Form.

Sales Tax Exempt Number
YES Lighting Sales Representative

Accounts Payable Contact Information

Full Name
Title
Phone Number
E-mail Address

Ship To Information: Location [#]

Location or Building Name
Street Address Line 1
Street Address Line 2
City
State
Zip Code
Delivery Notes

Engineer, Property Manager, or Onsite Personnel for Location [#]

Full Name
Title
Phone Number
E-mail Address
Add Another Location

Additional Information or Comments

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