Lumos Distributor Form
After receiving the following details through our distributor application, we will provide you with an info package.
Email address *
Company Name *
Your answer
Trading as
Your answer
Address *
Your answer
Contact Name *
Your answer
Contact Phone *
Please include your country and area code.
Your answer
Domain Name *
Your answer
Company Facebook page
Your answer
Other social media (if available)
Your answer
Year company established
Your answer
Region/Areas covered *
Your answer
Which stores do you distribute to? *
Your answer
Numbers of stores reached *
Your answer
Current range of products distributed *
Your answer
Brands carried
Your answer
Own warehouses?
Other notes/comments
Your answer
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