JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
ROKA London B2B Direct Application Form
Please complete the application form below to open a UK ROKA wholesale account. If you are in the EU please email us at
hello@rokalondon.com
ROKA London Ltd, 65 Howcroft Crescent, London N3 1PA. www.rokalondon,com
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Company Name
*
Your answer
Contact Full Name
*
Your answer
Phone Number
*
Your answer
Billing Details
Please add your billing address and details below
Billing Address
*
Your answer
City
*
Your answer
County
*
Your answer
Postcode
*
Your answer
Billing Phone Number
*
Your answer
Billing Email
*
Your answer
VAT Number
Your answer
Separate Shipping Address
Check if the Billing & Shipping Address is the same (please Shipping Address section)
Check if you have a separate Shipping Address and complete next section - you can add more later
Shipping Address
Your answer
Shipping City
Your answer
Shipping County
Your answer
Shipping Postcode
Your answer
How many stores do you have?
1
2
3
4
5-9
10+
Clear selection
How would you describe your store?
Gift Store
Clothing Store
Shoe Store
Garden Centre
Sustainable Store
Bags & Luggage
Coffee Shop
Museum
Parks/Leisure
Pharmacy
Furniture
Other
Clear selection
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of ROKA London.
Report Abuse
Forms
