News & Events

New T8 LED -
08/26/2013

To become an official DLU distributor, please fill out the form below.
A DLU representative will contact you with more details.

Company Name*		Federal Taxpayer ID*
Company Address*		California State Corporate ID #
		Dun & Bradstreet #
		E-mail Address*
Billing Address (If Different)		Corporation
		Partnership
		Sole Proprietorship
		Social Security #
Phone Number*		Fax Number*
Bank References (Please list general operating bank account information)
First Bank Reference		Second Bank Reference
Bank Name*		Bank Name
Bank Account #*		Bank Account #
Bank Contact		Bank Contact
Phone Number*		Phone Number
Fax Number		Fax Number
Credit References (Please list four credit references)
(1)Company Name*		(2)Company Name
Address*		Address
Phone Number*		Phone Number
Fax Number*		Fax Number
Contact Individual*		Contact Individual
(3)Company Name		(4)Company Name
Address		Address
Phone Number		Phone Number
Fax Number		Fax Number
Contact individual		Contact individual
Print Name: Title: Date*:
Security Code *

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