Create Your Account

Please enter your information below, we look forward to working with you!

First Name*:

Last Name*:

Email*:

Job Title:

Office Phone Number*:

Mobile Number:

Preferred Method of Contact*:

Company Legal Name*:

Company DBA:

Shipping Address:

Country*:

State/Province*:

City*:

Zip Code*:

Address 1*:

Address 2:

Billing Address:

Using Shipping Address

Website:

Number Of Employees:

Annual Purchase Amount (USD):

Primary Industries:

Secondary Industries:

Preferred Authorized Distributor*:

Distribution Number*:

Having More Distributors:

Yes

Preferred Authorized Distributor 2:

Distribution Number 2:

Preferred Authorized Distributor 3:

Distribution Number 3:

Preferred Authorized Distributor 4:

Distribution Number 4:

Preferred Authorized Distributor 5:

Distribution Number 5:

Tax ID (EIN) Number:

As part of the program, if the total amount equals to $600 or more annually, it is required to report the “Form W-9.” To comply with the requirement by the IRS, please provide the following information:

W-9 Form:

Seller's Permit:

Resale Certificate:

Please note: Luminys dealers without a valid seller’s permit or resales certificate will not be able to access the checkout section of Luminys Dealer Portal storefront.

Focused Groups:

Applicants will need to submit an eligible document to qualify your status. E.g. “Form 214” for veteran-owned business, certification from the National Women Business Owners Corporation (NWBOC) or the Women’s Business Enterprise National Council (WBENC) or certification from the National Minority Supplier Development Council (NMSDC). Luminys Technology USA has the final right to accept your application based on the submitted documents.

How did you hear about the Dealer Program?*: