Wholesale Application

Please complete the form below: We request that you complete EVERY field so we can properly evaluate your application. Failure to do so will delay your application process. Thank you and we look forward to working with you soon.. Kevin L. Wagner CEO “Lighthouse Man LLC”

Lighthouse Man Logo
Type of Business *
Are you Interested in: *
If you have a Web Site will you be adding them to your site? *
How did you hear about the Lighthouse Man? *

We require (2) Ttrade References, Please NO NOT include personal family or friends.  Business references ONLY

Please Provide the Following Information:

Business Name, Address, Phone Number, Contact Person

Business Name, Address, Phone#, Contact Person
Business Name, Address, Phone#, Contact Person

By clicking on the Submit button you are staing that you have the authority to purchase for your company and you are agreeing to the terms and policies of the Lighthouse Man. I, the purchaser named above, claim the right to make non-taxable purchases for resale of the taxable items available to me through Lighthouse Man LLC  I hereby certify that this merchandise is purchased for resale and I understand that if I make any use of the item(s) other than retention, demonstration, or display while holding it for sale, lease or rental, I must pay sales tax on the item of use based upon either the purchase price or the fair market rental value for the time period used. I further understand that it is a misdemeanor to give a Resale Certificate to a seller for taxable items which I know are purchased for use rather that resale, rental or lease.

Please Read:  Applicant understands that if accepted as an account of Lighthouse Man LLC orders will be subject to acceptance at its office at 340 Hoffa Mill Rd., Lewisburg, PA 17837, and at all terms and conditions current at the time of order acceptance. Prices, terms and special discounts may be changed without prior notice to the customer. Applicant further agrees that if accepted as an account all orders will be deemed to have entered into Union County, Pennsylvania, shall be interpreted in accordance with the laws of the state of Pennsylvania. Applicants understand that payment must be made prior to shipment. Applicant agrees to notify Lighthouse Man LLC  in writing within ten days of any change in partnership, corporation or legal structure of applicant’s business and further agrees that applicant will continue to remain liable to Lighthouse Man LLC for any unpaid balance due.

Lighthouse Man LLC 340 Hoffa Mill Road Lewisburg, PA 17837