Partnership Application Step 1 of 4 25% CompanyCompany Name(Required) Company Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Company Website Company Profile on LinkedIn Primary ContactPerson responsible for partnership.Name(Required) First Last Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail(Required) Billing Contact (Optional)Person responsible for billing if different than above.Name First Last Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail PartnershipPartnership(Required)Diamond, $15KPlatinum, $10KGold, $5KSilver, $2500Testing, $5Total Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name Consent(Required) I agree to the partnership agreement.The partnership is not confirmed until AAILA receives payment in full. If AAILA does not receive payment within thirty (30) days, the partnership is subject to termination, and all benefits will be placed on hold. This agreement represents a commitment to become an AAILA partner and shall serve as a binding agreement between AAILA and the partnering company, constituting their entire agreement regardless of prior negotiations and understandings.In the case of any act or cause outside of the control of AAILA or partnering company, including, but not limited to acts of war, terrorism, fire, strike, or natural disaster, that makes the fulfillment of the partnership impossible or inadvisable, AAILA may retain such part of the partner’s fees as shall be required to recompense it for its expenses and obligations related to the participation. Notwithstanding the foregoing, AAILA shall attempt to maximize its resources to avoid any such liabilities. Partner acknowledges their participation with AAILA is at the sole business discretion of AAILA. By virtue of partner’s decision to participate as an AAILA Partner, partner agrees they will not directly or indirectly, expressly or implicitly solicit, recruit or otherwise promote to AAILA participants any product, service or organization that is in any way competitive with AAILA without the advanced, expressed written permission of AAILA. Δ Need help with this form? info@lightingagents.org
