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Dealer Referral Program
*Company Name:
*Primary Contact:
*Address 1:
Address 2:
*Zip / Postal Code:
*Phone:   123-456-7890
Fax:   123-456-7890

*What territory do you cover for home lighting automation?

Please list all countries, states or zip codes

In how many homes have you installed Simply Automated UPB products in the past year?
more than 10
*How many Simply-Automated switches does your company sell or install per year?
more than 250
*Have you or someone else with your company, attended one of Simply Automated's FREE Manufacturer's Training?


  Yes   No
If so, where and when?
*How many full time employees does your company have? 0-5
more than 10
*What are the primary products that your company installs or sells?

From which Distributors
do you buy Simply Automated Products?

Check all that apply

AARtech Canada
All-Phase Electric Co.
Automated Outlet
Automation & Security Technologies, Inc.
DPC Distributors, Inc.
EECOL Electric
Group One NW, Inc.
Home Controls, Inc.
Home Innovation Distributors
HomeTech Solutions
Martin's Security
Mathes Electric Supply Company
Quantum Electronic Systems
Sesco Datacom / State Electric Supply Co.
Smart Box
SmartHome USA
SmartHome, Inc
The Systems Depot
Warshauer Electric
W.B. Cross Co.
Worthington Distribution
Please include me in Simply Automated's Dealer Information Program   Yes   No
Send confirmation by:   Email Fax
Once we receive your application, we will validate the information
and respond to you within 2 business days via email or fax
  * requited to submit


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