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Cherlone Dress RESELLER APPLICATION FORM

NOTE: If you already have an account with us, please login at the login page.
Your Personal Details * Required information
First Name:  *
Last Name:  *
E-Mail Address:  *
Company Details
Company Name:  
Your Address
Street Address:  *
House Number:  
Post Code:  *
City:  *
State/Province:  *
Country:  *
Your Contact Information
Telephone Number:  *
Fax Number:  
Your account may not be approved if the information you provided is insufficient.
BUSINESS CONTACT INFORMATION
How do you plan to sell our products:
Website address ( if aplicable):
Company name:
Phone:
Fax:
E-mail:
Register company address:
County:
City:
Post Code:
Country:
Date business commenced:
Sole proprietorship:
Partnership:
Corporation:
Other:
PERSONAL CONTACT INFORMATION:
Primary home address:
County:
City:
Post Code:
Country:
How long at current address?:
Telephone:
Fax:
E-mail:
Please supply us your e-mail address that you use regularly, any Cherlone products ordering discussions will only be made upon the e-mail address that you supply to us now if your application is accepted.
WE WILL GET BACK TO YOU AS SOON AS YOUR RESELLER APPLICATION IS APPROVED ANY QUERIES ON FILLING THIS APPLICATION FORM PLEASE CONTACT: DRESS@CHERLONE.CO.UK
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