NEW WHOLESALE ACCOUNT

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CUSTOMER DETAILS FORM

Contact Name *

Primary Phone Number *

Mobile Number

Email Address *

Unless you tell us otherwise this email address will be used to send marketing material

Company *

Trading Name

ABN

Type of business

Shipping Address (please include state and postcode) *

Billing Address

Same as above

Billing Address

Accounts: Contact Name

Accounts: Phone Number

Accounts: Email Address

Preferred Payment Option *

Credit Card (5% discount over $500)

Direct Deposit (5% discount over $500)

Required

Frontline Account Number (If applicable)

How did you hear about Vaniggy Fashions? *

Submit

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