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Application for Wholesale Account
Complete this form to become a stockist of The Simplest Remedy's unique flower essence formulations.
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Email
*
Your email
Option 1
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Company Name
*
Your answer
Company ABN
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Your answer
Trading Name (if different to Company Name)
Your answer
Type of Business
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Year Business Established
*
Your answer
Company Address
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Company Postal Address (if different)
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Company Phone Number 1
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Company Phone Number 2
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How did you hear about this range?
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Accounts Contact Full Name
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Accounts Contact Phone
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Accounts Contact Email
*
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I confirm that the above information is an application for a wholesale account to stock The Simplest Remedy's flower essence range.
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I confirm that the above information contains true and accurate information about my business/company.
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I understand that my business contact information will be included as a stockist outlet on supplier websites.
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