Become a Dealer 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 SetupEnter the name of the business representative, company and email you would like associated with the account.Name* First Last Business Name*Email* Billing AddressEnter the billing address for the company.Address*Line 1AddressLine 2Town/CityState*SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZipcode*Country*Company InformationPhone Number - Office*Phone Number - MobileFax NumberCompany 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?*YesNoWhat products do you currently offer to your customers?*Please list Brands.What interests you in becoming a dealer for Lighted Impressions?*Please specify.CommentsThis field is for validation purposes and should be left unchanged.