Form

Prospective Vendor Submission Form

Primary Contact Information

Company Contact Information

Business Information

This is not an application to become a Batteries Plus Bulbs/Ascent vendor. If your business is selected, there will be another process to qualify you as an approved supplier. Our buying team receives hundreds of prospective vendor requests a year, so it is important that this form be filled out completely and correctly. It takes time to review these submissions, so please be patient. You will receive a notification that your submission has been received.