Luxxxxe Affiliate Application
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Instagram Handle
*
Tik Tik Handle
*
What Brands or Companies have you been an affiliate with in the past? Please include dates.
*
What Brands or Companies are you currently working with?
*
Submit
Should be Empty: