Become a Dealer - Lighted Impressions

Do you want to carry Lighted Impressions products? Apply to become a dealer by using the form below.

Please fill out the required fields and an agent will contact you after your application has been reviewed.

Account Setup
Enter the name of the business representative, company and email you would like associated with the account.
Name*
First Last
Business Name*
Email*
Billing Address
Enter the billing address for the company.
Address*
Line 1
Address
Line 2
Town/City
State*
Zipcode*
This field is hidden when viewing the form
Country*
Company Information
Phone Number - Office*
Phone Number - Mobile
Fax Number
Company Website
Tax ID Number*
(EIN)
What is the geographical area that you cover?*
What is your estimated annual sales volume?*
What trade do you sell to?
Do you have a showroom?*
- Yes
- No
What products do you currently offer to your customers?*
Please list Brands.
How did you hear about Lighted Impressions?*
Please specify.
Phone
This field is for validation purposes and should be left unchanged.

Account Setup