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Fialuna New Retailer Application Form
If you are an established retailer and are interested in carrying our products, please provide ALL of the following information to be considered for a wholesale account:
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* Indicates required question
Email
*
Your email
Business Name:
*
Your answer
Contact Name (person responsible for purchasing):
*
Your answer
Telephone Number:
*
Your answer
Business Address:
*
Your answer
VAT Number (if applicable):
Your answer
Company Registration Number (if applicable):
Your answer
Registered Address (if applicable):
Your answer
Number of years in business:
*
Your answer
Do you sell online, in a storefront or both?
*
Online
Storefront
Both
Other
Website URL (if applicable):
Your answer
Do you agree to Fialuna's Wholesale Terms and Conditions?
*
Please read the Wholesale T&Cs here:
https://drive.google.com/open?id=1QvMwIyF-l7Hc8r6hDByGcOh6pByo_8xO
Yes
Required
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