Luxx Lighting Dealer Application

To apply to become a Luxx dealer please complete this form. An account manager will contact you within 2 business days.

Your Information

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Store Information

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Invalid entries will take longer to process.

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The most accurate way to determine your Luxx Lighting product & inventory needs is based off of the number of lights your customers are growing with. Approximately how many lights do you anticipate providing products for at this time?

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Luxx Lighting Dealer Application

Luxx Lighting Dealer Application

To apply to become a Luxx dealer please complete this form. An account manager will contact you within 2 business days.

Your Information

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Store Information

Company Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Website {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Reseller Permit (California Only) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Tell us about your store {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Untitled {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Instagram {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Facebook {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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