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New User Registration

Step

Passwords must contain at least 6 characters including one number and one letter. "Fido04" is an example. Passwords are case sensitive. Please see our Privacy Policy for more information.

Customer No. Assigned when registration is completed.
Contact Email*
Confirm Email*
Username*
Password* Must contain at least 6 characters, including one number and one letter.
Confirm Password*
Primary Use for Purchases Made Through This Bulbtronics Account*
Security Question*
Security Answer*


Name (Greeting, First, Last)
Company *
Phone * Omit All Punctuation
Buying Group Name/Number


Billing/Shipping Information

If your billing and shipping information are the same, use the check box under Shipping Information and the same information will appear in the shipping fields. Once registered, you will be able to add additional shippping addresses. If the fields are prepopulated please update.

Billing Information

Company
Attention
Ste. / Bldg. / Apt # / Unit
Address *
City *
State *
Zip Code*
Phone * Omit All Punctuation
Email Address *
Click here to copy contact email

Shipping Information

Same as billing information
Company
Attention
Ste. / Bldg. / Apt # / Unit
Address *
City *
State *
Zip Code*
Phone * Omit All Punctuation
Email Address *
Click here to copy contact email
Address Type*


Contact Information

If you are a reseller, and choose "yes", you will be required to provide additional information to Bulbtronics to process your registration.

Choose the Market That Best Describes Your Business*
Are You a Reseller? Are you reselling the products you buy from Bulbtronics?
Allow Future Correspondence for Products, Specials and Promotions.
How Did You Hear About Bulbtronics?

If your company is Tax Exempt, fax a copy of your certificate to 631-756-8385. Certificate must be on file before first order is shipped or applicable sales tax will be added.



Reseller Qualifications

You have identified yourself as a reseller account
If you are not a reseller, Please to the previous page and change "yes" to "no".
If you are a reseller, please complete the form below. Pending a review of this infromation, you will be qualified as a reseller.

Company Name*
Your Address*
This Address is a
Branch
Headquarters
Headquarters Address
Contact at headquarters it other than you
Total Number of employees companywide *
How many branch or locations does the company have?*
List Principal(s) *
Annual Sales *
Accounts Payable Manager*
Accounts Payable Phone(include ext)*
How Long at Present Address ? *
Year Business Established *
Resale Tax No.(s) *

Fax tax certificate to 1-631-756-8385. Certificate must be on file before first order is shipped or applicable sales tax will be added

Business is
Corp
Partnership
Sole Proprietor
Date Incorporated
State or Country of Incorporation
Company description *

Include what you sell and whom you sell to so we can better service you

List product lines currently carried *
List those authorized to purchase for the company

If you wish to authorize more employees to purchase on-line, please contact us at 1-800-588-BULB

Business Reference

Company / Facility *
Address *
Contact Person *
Contact Phone *
Contact Fax
Contact E-mail


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