Lumos Helmet Dealer Application
After receiving the following details through our dealer application, we will provide you with a full retailer info package including retailer terms and price lists
Email address *
Store Name *
Your answer
Registered Company Name *
Your answer
Full Business Address (#, Street, State/Region, Country) *
Your answer
Contact Name *
Your answer
Contact Phone *
Your answer
Business Website *
Your answer
Company Facebook page (if available)
Your answer
Business Instagram Page (if available)
Your answer
Yelp/ Other Social media sites (if available)
Your answer
Type of Store (select all that apply) *
Required
Number of stores?
Your answer
Size of Largest Store (Sq ft)? *
Your answer
Years in business?
Your answer
Description of Business (1-2 sentence summary is sufficient.) *
Your answer
Types of customers who shop with you? *
Required
What other bike helmet brands do you currently carry? *
Your answer
Top selling brands in your store currently? *
Your answer
It is important for Lumos to be prominently displayed in a retail store. Attached is an image of our current in store display units. Would you be able to accommodate such a display (table or wall mounted) and where in your store would you potentially place it (we might ask for an image by email). AVAILABLE IN JULY 2017 *
Your answer
Lumos Wall Mount
Lumos Table Display
Any questions, comments, or feedback for us? Feel free to leave them here!
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Next Steps
After receiving your form submission, we will review the information and get back to you by email to arrange a brief call to discuss cooperation further.

Ride Safe!
The Lumos Team
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