Spex Dealer Application Form

Spex Dealer Application Form

Please complete the form below to apply. Our team will review your submission and be in touch with next steps.
Business identity & trading profile
Legal business name*
Trading name (if different)
Company registration number*
VAT/Tax ID number
Sole TraderPartnershipLimited Company (Ltd)Limited Liability Partnership (LLP)Public Limited Company (PLC)Charity / Non-profitPublic Sector / GovernmentOther
Operational & delivery details
Head office (shipping) address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
YesNo
Invoice & mailing address if different*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Account setup details
Primary contact name*

First NameLast Name
Primary contact job title *
Primary contact number *
Primary contact e-mail*
example@example.com
Accounts payable information
Accounts payable contact person*

First NameLast Name
Accounts contact number *
Accounts payable email*
example@example.com
Bank name*
IBAN/Account number
SWIFT/BIC code
Purchase order contact
Same as primary contactSame as accounts payable contactSomeone else
Purchase order contact

First NameLast Name
Purchase order email
example@example.com
Commercial
Website*
What territories and markets do you serve
What product brands do you already sell
Declaration
Signature*

Clear
Should be Empty:

Purchase order contact