Skin Care Partner Registration

Anna Lotan Skin Care Partner Application

Yes, I would like to become an Anna Lotan Skin Care Partner!!

If you are a Licensed Skin Care Professional or Business Owner and wish to become an Anna Lotan Skin Care Partner, please complete and submit the following requested information.

Please note that you will be required to submit a copy of your Professional or Business license in order to verify your Professional status. If, for any reason, you are unable to do so you should Contact Us and we can arrange an alternative process.

Although this site was initially designed for US Skin Care Professionals, we also now extend an invitation to skin care professionals from certain other countries, where we do not currently have a formal distribution network, including, but not limited to: Cyprus, Denmark, France, Germany, Portugal, South Africa, Spain, Switzerland, United Kingdom - and you are welcome to apply for international membership in the Anna Lotan Skin Care Partner Program.

(Canadian Skin Care Professionals should always contact our Canadian distributor in Toronto: EDVA Products, Tel: 416-789-5878 or info@edvaproducts.com ; Israeli Skin Care Professionals should always contact Anna Lotan directly Tel: 04-629-5000 or info@annalotan.co.il ).

Personal information
Title:
First name:*
Last name:*
Business information
Business Name:*
Business License#:*
Addr1:*
Addr2:
City:*
State/Province: PostCode:*
Country:
Shipping Address
Same as address
Addr1:*
Addr2:*
City:*
State/Province: PostCode:*
Country:
Contact information
Phone:*
Mobile:*
Email:*
Web site:
Additional Information
Are you an aesthetician?:* YesNo
Professional license:*
Please attach a copy of your Licence:*
What is your position?:*
What type of facility do you work at?:*
Number of Staff at your Facility:*
Do you have Purchasing Authority?:* YesNo
Are you looking to change Skin Care Lines?:* YesNo
How did you hear about us?:*
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Verification*

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The letters are not case-sensitive. Do not type spaces between the numbers and letters.

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Skin Care Partner Registration

Anna Lotan Skin Care Partner Application

Yes, I would like to become an Anna Lotan Skin Care Partner!!

Personal information

Business information

Shipping Address

Contact information

Additional Information