Retailer Sign-Up Form

Retailer Sign-Up Form

Please fill out the form below to register your store for The Discovery Stand.

Contact and Delivery Details
Contact Persons Full Name*

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

Area CodePhone Number
Number for Comms Whatsapp Group

Area CodePhone Number
Deliveries
Store Address for Deliveries *

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Delivery Notes

Payment Information
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Invoicing and Accounts Contact Details

First NameLast Name
Area CodePhone Number
Email
Payment Terms
Company Registration Number
VAT Number (If applicable)
Optional
Purchase Order (PO) Number Required?

YesNo

Next Steps
Please schedule a 15 minute onboarding call...
Should be Empty: