Customer Application Form

Print Form

Please fill the form below to submit your details for new account setup with Lutron.

Today's Date:
Application Type: ED
Required fields in black

1General Information

Company Infomation
Legal Company Name
Phone
D/B/A Name (If Applicable)
Fax
Web Address
Company Email
Billing Address
Address where invoices will be sent
Address Line 1
Address Line 2
Address Line 3
Country
State / Province
City
Zip Code / Postal Code
County
Shipping Address
Address where products ship, cannot be a PO Box.
Same as Billing Address
Address Line 1
Address Line 2
Address Line 3
Country
State / Province
City
Zip Code / Postal Code
County
Accounts Payable Contact
First Name
Last Name
Email
Phone
Lutron Email Invoice Enrollment
Primary E-mail
Secondary E-mail
(Please provide A/P mailbox information if applicable)
Same as Accounts Payable Contact
Contact First Name
Contact Last Name
Contact Email Address
Contact Phone
By completing this form you hereby authorize and request Lutron to send invoices and credits in PDF form via unencrypted email to the mailbox address noted above in lieu of sending paper invoices and credits.

This authority is to remain in full force and effect until Lutron has received notification of its termination in such time and in such manner as to afford a reasonable opportunity to act on it.

2Key Contacts

Must fill out at least one contact (Required: Owner or Branch Manager)
Owner
First Name
Last Name
Email (used for myLutron login)
Phone
Branch Manager
First Name
Last Name
Email
Phone
Lutron Sales Champion
First Name
Last Name
Email
Phone
Purchasing Manager
First Name
Last Name
Email
Phone
Sales Marketing Lead
First Name
Last Name
Email
Phone
Project Manager
First Name
Last Name
Email
Phone

3Account Profile

PO #
Order Amount
Account Profile
Account Type

4Your Contact Information

Please fill out with your contact information
Name
Company Name
Title
Email
Phone

5 Upload Documents

Note
*Only txt, doc, xls, docx, xlsx, pdf, jpg, png are allowed
*Per document limit is 10 MB.
Credit Application
Tax Certificate
Purchase Order
Other Documents
Captcha code is case sensitive
Please confirm
The undersigned, as an owner, partner, officer, or agent of the applicant :
  • Authorizes Lutron Electronics Co., Inc. to make inquiries as necessary to verify accuracy of the information contained in the application
  • Certifies that all the information contained in the application is true and correct to the best of his/her knowledge
Lutron Credit Application:

We would like to take this opportunity to thank you for your interest in the many Lutron Electronics Co., Inc. products and your desire to establish credit with our company. We look forward to establishing a professional relationship that will be mutually rewarding. Please click on the link below to begin the application.

US Credit Application


Terms and Condition of Sale:
US Agreement
Accept agreement
I accept Lutron Electronic Co., Inc.'s terms and condition of sale