Wholesale Application Form

1

Name* This field is required.

First Name

Last Name

2

Email* This field is required.

example@example.com

3

Business name and year of establishment:

4

Please tell us a little about your business and why you would like to stock Lorum

5

Please tell us your location and what shopfront you have (ex. Plaza, stand-alone, home-based ect) Lorum is exclusive to one stockist per suburb. If there is already a stockist in your area, unfortunately, we will not be able to have you stock our products. However, we will put you on our waitlist if the other stockist withdraws.

6

Please show us a photo of your business and where Lorum will be displayed

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