BECOME A STOCKIST

Trading Name* Trading Since*

Trading Address*
Suburb*
Postcode* State*

NZBN or ABN Number* GST Registered?*

Name of Reg'd Company(if applicable)

Company Address*
Suburb*
Postcode* State*

Type of Business*
Sole TraderPartnershipReg'd CompanyTrust

Retail Store*
YesNo

If Yes, How many?
*If you have multiple retail stores, please attach a list of trading addresses for each store.

Web sales*
YesNo

Web address:
* Web sales only via proprietary owned shopping cart on your own URL not via 3rd party sales/auction sites

Contact Name*

Phone Number*

Mobile Number*

Email*

Owner's Name*

Owner's Email*

*Required