Amped Contact Form

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Amped Contact Form

Thank you for your interest in Amped Innovation. Please fill in the commercial form below and a member of the team will contact you via email or phone. By filling in the form, you agree to our Privacy Policy and Terms and Conditions.

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First Name *

Last Name *

Professional Title *

If you are only an energy consumer interested in Amped products as a consumer, please write "Consumer."

Company *

Professional Email *

Professional Phone Number *

Please select what best describes you and your interest in Amped Innovation. *

Country *

Please select the Amped products you are interested in. *

Solar Lighting and Phone Charging kit

Solar Television Kit

EasyFreeze Kit

Solar Fan Kit

Solar Generator Kit

Other:

Required

When do you plan to purchase Amped products? *

How many Amped solar appliances would you like to purchase this year? *

If you are a distributor or business, please estimate your expected budget for Amped Innovation solar products. *

Business website URL (write, n/a if you're an individual consumer.) *

Are you able to make a minimum down payment of 15% and warehouse the products locally? *

Yes

Maybe

N/A - I am a consumer.

Have you received any grant funding or other forms of financing to distribute solar products? *

Yes

Maybe

N/A - I am a consumer.

Have you sold PAYGO products before? *

If you are a distributor or business, are you able to accept containers of product in China instead of within your country of operation?
*

If you are a distributor or business, what is your annual revenue?
*

LinkedIn URL (optional)

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