If you are a skincare professional looking to take your clinic or spa to the next level, we would love to introduce you to Lira Clinical! Please submit the new account application below and we will follow up with you soon!

First Name *

Last Name *

Email Address *

Phone Number *

Company Name or School Name *

Type of License *

Valid License or Student ID # *

State Licensed in *

License Expiration Date *

Copy of your professional license *

Choose file or drag here

Supported format: JPG, JPEG, PDF, PNG, GIF, SVG, DOC, DOCX.

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Supported format: JPG, JPEG, PDF, PNG, GIF, SVG, DOC, DOCX.

Resale Certificate Number

Resale Certificate Expiration Date

Upload a copy of your reseller’s certificate

Supported format: JPG, JPEG, PDF, PNG, GIF, SVG.

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Supported format: JPG, JPEG, PDF, PNG, GIF, SVG.

Shipping Address (Address Line 1) *

Address Line 2 *

Country *

state/province/region *

City *

Zip Code *

Agree to Retail Distribution Terms and Conditions https://liraclinical.myshopify.com/pages/reseller-agreement *

Thanks for getting in touch!

Thank you! We received your application to become a Lira Clinical professional. We’ll review your submission and you’ll receive an email once approved.

Thank you and Be Bright. Be Beautiful!

Thanks for getting in touch!

Thank you! We received your application to become a Lira Clinical professional. We’ll review your submission and you’ll receive an email once approved.

Thank you and Be Bright. Be Beautiful!

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Skincare Quiz

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Skincare Quiz

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Skincare Quiz

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