Dealer Application

Thank you for your interest in Advance Technologies Distribution Center. Please fill out the application below to begin the process of becoming one of our dealers. Once completed, one of our sales representatives will contact you to discuss your business needs.

BUSINESS INFORMATION

Business Name

Owner's Name

Billing Address

City

State

Country

Zip Code

Same as billing? Same as billing? Yes

Physical Address

City

State

Country

Zip Code

Phone Number

Email ID

Company Website

Tax Exempt I.D. Number

Federal I.D. Number

Years in Business

Number of LEDs Sold

Number of Employees

LEDs Installed

Manufacturer

Brands Carried

Choose One Choose One Retail Wholesale Both

Company Name

Address

Contact

Phone

Company Name

Address

Contact

Phone

Company Name

Address

Contact

Phone