Lillagunga - Product Claim Form

Retailer application

Kindly fill in all required fields. The more precise your submission is, the easier it is for us to process it and return to you. Please note that we will reserve 1-2 days before we will respond.
Company name*
Website*
VAT Number*
Primary contact*

First NameLast Name
Email*
Phone*

Company facts
Founded*
Number of employees*
Turnover*
We are interested in:

Drop shippingStockingBoth

Shipping Information
Primary contact person

First NameLast Name
Shipping address*

Street Address *

Street Address #2 (optional)

City *State / Province (optional)

Postal / Zip Code *Country *

Invoicing information
Primary contact person

First NameLast Name
Email adress for invoicing*
example@example.com
Invoicing address*

Street Address *

Street Address #2 (optional)

City *State / Province (optional)

Postal / Zip Code *Country *

Review and submit
Where did you first learn about Lillagunga:*

Social mediaAnother retailerA friend or relativeOther
Newsletter for Retailers

Yes, subscribe me to this newsletter.
Should be Empty: