Customer #
DEWY LEWYSKINCARE
New Stockist Application Form
Business Name
*
Your Name
*
First Name
Last Name
Salon Delivery Address
*
Street Number
Street
Suburb
State
Post Code
Company/Business ABN/ACN
*
Business Phone
*
Mobile Phone
*
Email
example@example.com
Is it OK if we ?
send occasional SMS Marketing
-
send occasional Email Marketing
Company Website
*
Company Instagram
*
Type of Business:
*
e.g salon, spa, clinical
Year Established:
*
Current Skincare brands you stock:
*
Treatments performed
*
Number of Treatment Rooms
*
Please Select
1
2
3
4
5
6
7
8+
Do you commit to completing Dewy + Lewy Skincare training?
*
YES
NO
Monthly expected retail sales of Dewy + Lewy Skincare $
amount
*
Signature
Thank you
once your application has been successful you will receive a copy of our trading terms & conditions
Submit
Should be Empty: