Affirmations Wholesale Customer Registration Form

Wholesale Registration Form
This is the form to fill out if you want to start stocking our lovely products. Please note that the minimum opening order is $500, and the minimum refill order is $300.

If you're already a stockist then you don't need to fill out this form - we've already got your details and have set you up automatically with an online account. Give us a call on 1800 222 254 and we'll get you started.
Your Name

First NameLast Name
Your First Name*
Your Last Name*
Your Email*
Your Mobile*
Format: 0000 000 000.
Your preferred contact method
Your birthday*
Day
*
Month
Your Position*

Sole TraderPartnerFranchiseeCompany DirectorTrusteeManagerBuyer

About Your Business
Business Trading Name*
Form of Ownership*
Business Legal Name
Business Phone Number

Area CodePhone Number
Business Email*
example@example.com
Business Street Address Line 1
Business Street Address Line 2
Suburb/Town/City
State
Post Code
Country
Is your shipping address the same as your business address?*
Shipping Street Address Line 1
Shipping Street Address Line 2
Shipping Suburb/Town/City
Shipping State
Shipping Post Code
Shipping Country
Shipping Address*

Street Address

Street Address Line 2

Suburb/Town/CityState

PostcodeCountry
Do you receive letter sized mail at your business address?*
Some of our shopping centre customers have to use a different address for letter sized mail, like our catalogues.
Street Address Line 1 for catalogue
Street Address Line 2 for catalogue
Suburb/Town/City for catalogue
State for catalogue
Post Code for catalogue
Catalogue Country
Postal Address for Catalogues

PO Box/Street Address

Street Address Line 2

Suburb/Town/CityState

Postcode
Business website
Do you have business social media accounts we can follow?
Type of store*

AccommodationBookshopBusiness NetworkingCafeChildren's ShopClothing StoreDistributorFloristGalleryGift ShopHealth & WellnessLicenseeMarketsMind Body SpiritNewsagencyNurseryOnline StorePet/Animal ThemePetrol StationPharmacyPost OfficeSpeciality Card StoreTobacconistsOther
Do you own any other stores?

YesNo
Details of other store/s
Are you part of any of these centrally billed or buying groups:

BookPeopleDymocksLeading EdgeNewsPowerNewsXpressNextraSindhiz GroupTSGWH SmithOther

That's it - this is the last bit!
Is there anything else we should know about?
*

I am an authorised signatory for this business and I agree to Affirmations Publishing terms and conditions
Should be Empty:

Wholesale Registration Form

About Your Business

Working Together

That's it - this is the last bit!