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Pharmacoo Wholesale Sign Up Form
For us to understand if we are a good fit, please fill out the application form below and we will get in touch with you!
Please note that we only accept applications from
Australia
and
New Zealand.
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* Indicates required question
Email
*
Your email
Company Name
*
Your answer
Trading Name
If it's different to your registered company name
Your answer
ABN (for AUS)
*
For NZ, please fill in your NZBN
Your answer
Full name
*
Your answer
Email
*
Your answer
Phone number
*
Your answer
Your Role in The Company
*
Your answer
Which brand(s) are you interested in?
*
Your answer
Business Address Line 1
*
Your answer
Business Address Line 2
*
Your answer
Suburb
*
Your answer
State
*
Your answer
Postcode
*
Your answer
Business Activity/ Sales Channels
*
Please tick all that applies
Beauty Clinic/ Beauty Salon
Online Retailer
Retail Shop
Pharmacy
Supermarket
Amazon/Ebay/ Other marketplaces
Group Buy
Other:
Required
Website (If not applicable, put N/A)
*
Your answer
How did you know about us?
*
Google
Web search
Little Red Book
Social media
Other:
How would you like to get in touch?
*
Email
Phone call
Text Messages
Wechat
Other:
Send me a copy of my responses.
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