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NEW WHOLESALE ACCOUNT
CUSTOMER DETAILS
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* Indicates required question
Contact Name
*
Your answer
Primary Phone Number
*
Your answer
Mobile Number (if different to above)
Your answer
Email Address
*
Unless you tell us otherwise this email address will be used to send marketing material
Your answer
Company name
*
Your answer
Store Trading Name (if different to above)
Your answer
ABN
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Type of business
*
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Department Store
Franchisee
Tourist Shop
Variety Store
Gift Shop
Sports Store
Boutique
Newsagent
Chemist
Surf Shop
Fashion Outlet
Other
Is this a storefront or an online store?
*
Storefront
Online store
Both
Store address (if applicable)
*Please include state and postcode
*Please include all addresses if there are mutliple stores
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Shipping Address
*
Same as above
Other:
Required
Billing Address
Same as above
Other:
Accounts: Contact Name
Your answer
Accounts: Phone Number
Your answer
Accounts: Email Address
Your answer
Preferred Payment Option
*
Credit Card (5% discount over $500)
Direct Deposit (5% discount over $500)
Required
Frontline Account Number (If applicable)
Your answer
How did you hear about Vaniggy Fashions?
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Recommended by another store
Vaniggy Fashions Sales Rep
Google Search
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Website
Purchased a product and researched company
Other
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