Online Distributor Application Form For uSaveLED Products

Thank you for your interest in becoming a Distributor of uSaveLED products. Please fill out the Distributor Application form below and a uSaveLED Team Member will be reaching out to you shortly.

We do not require any minimum quantity or dollar amount for distributor purchases and offer free shipping anywhere in continental USA on orders over $2,500.00! uSaveLED Distributors also benefit from Free Photometric Lighting Designs, Expert Product Specification, and email updates with the latest uSaveLED products and promotions.

When your account is approved, you will receive a notice to the e-mail address you provide with your Distributor Agreement. This Distributor Agreement will contain information about our dealer margins, and ordering process.

BUSINESS CONTACT INFORMATION
Company name:*
Primary Contact Name*
Business trading name:
- Managing Director(s):
- Owner(s):
- Phone*
- Fax
- Mobile
- Email*
- Website
- FEIN:*
- Social Media:
Billing address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Shipping address (if different from Billing Address):
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
COMPANY BACKGROUND
- Number of employees:
- Number of years distributing LED products
Please describe your company history: (You can include a link if you have history on your website.)
Your current top selling lighting products:
- Accounts Payable Contact Name
- Email
- Phone
- Sales Manager name:
- Email
- Phone

Current annual sales (in USD):

Areas of Service ( List all States and Countries)

Describe your distribution network (how many sales representatives, account managers, how many agents, direct to retail, sub-distributors etc):

PURCHASING PLAN

Which products are you interested in purchasing?

Expected opening order amount:

Estimated date your first order will be placed:
MM slash DD slash YYYY

How many orders per year do you anticipate?

PAYMENT TERMS

Requested Terms (Requires Credit Application):*

DISTRIBUTOR DECLARATION

The above information I have provided is true and correct at the time of submission. I understand that this form is not a contract for distribution with uSaveLED. I understand that this application will be assessed and I will be contacted by a representative of uSaveLED and informed of the outcome.

Name:*

Title:*

Date
MM slash DD slash YYYY

CAPTCHA

BUSINESS CONTACT INFORMATION

COMPANY BACKGROUND

PURCHASING PLAN

PAYMENT TERMS

DISTRIBUTOR DECLARATION

Enter your Information and someone will be in contact with you shorlty