To register as a LuxSci affiliate, please enter your name, address, and email address below. Your email address will be your login and we will send you your password once your registration is complete. The "PayPal Email Address" is not required, but if you have one, it will assist us in verifying your account; you can also opt to have commissions paid to you via PayPal instead of check.
We will use the contact information that you provide below to verify your account. Commissions will not be paid until your account is verified, so be as accurate and complete as possible.
Fields marked with a (*) are required.
