Application for Wholesale Account
Complete this form to become a stockist of The Simplest Remedy's unique flower essence formulations.
Email address *
Clear selection
Company Name *
Company ABN *
Trading Name (if different to Company Name)
Type of Business *
Year Business Established *
Company Address *
Company Postal Address (if different)
Company Phone Number 1 *
Company Phone Number 2
How did you hear about this range? *
Accounts Contact Full Name *
Accounts Contact Phone *
Accounts Contact Email *
I confirm that the above information is an application for a wholesale account to stock The Simplest Remedy's flower essence range. *
Required
I confirm that the above information contains true and accurate information about my business/company. *
Required
I understand that my business contact information will be included as a stockist outlet on supplier websites. *
Required
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