Wholesale - Application Form
DEMES wholesale application and contact information form
Email address *
Retailer or Distributor Name *
Your answer
Purchasing Contact *
Purchaser's contact name, First and Last
Your answer
Email *
Your answer
Phone number (required for shipping purposes) *
Your answer
Your website URL
Your answer
Street Address *
Street number and street name
Your answer
City *
Your answer
Province / State *
Your answer
Country
Your answer
Postal or Zip Code
Your answer
Where you plan to sell DEMES products: *
(Check all that apply)
Required
Reseller type *
Required
How will you purchase from DEMES *
Required
Are you seeking DEMES exclusivity (regional only)?
Will you use your own shipping account (distributor)
Product Interest (select products you are interested in reselling) *
Required
A copy of your responses will be emailed to the address you provided.
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