KIKI Health - Trade/Wholesale Application

KIKI Health - Trade/Wholesale Application
Company Name

Company Name Trading Name if Different
VAT Registration Number Company Registration Number
Company Registered Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Website Address
Number Of Employees
Type of organisation
Type Of Business
Estimated Annual Expenditure
Requested Credit Limit
Requested Payment Terms (from invoice date)

Purchasing Department Details
Contact Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com

Delivery Details (If different from company registered address)
Contact Name

First NameLast Name
Delivery Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com

Accounts Department Details
Contact Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Billing/Invoice Address (if different from company registered address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Trade References
Trade Reference 1
Company Name
Position
Contact Name

First NameLast Name
Contact Email
example@example.com
Phone Number

Area CodePhone Number
Trade Reference 2
Company Name
Position
Contact Name

First NameLast Name
Contact Email
example@example.com
Phone Number

Area CodePhone Number

Customer Declaration and Acknowledgment
By signing this form, I attest that the information I have provided is true, accurate, and can be verified. Failure to complete all sections of this form, or to supply all the required documentation may cause the application to be rejected.

I hereby agree to not list/actively sell any KIKI Health products on any form of global marketplace, these include Ebay, Amazon, Etsy etc. If I am unsure I will check with KIKI Limited before listing.

KIKI Limited holds all rights to stop supplying if products are found on any global marketplace with the authority to request the products are removed from these marketplaces. KIKI Limited will not accept any returns/refunds back for products that were purchased for the above reasons.
Name

First NameLast Name
Position held
Date

MonthDayYear
Date
Should be Empty: