WHOLESALE REQUEST FORM Your Full Name Company Name Company Registration Number Type of Company Type of CompanyRetail StoreSouth Africa DistributorInternational Distributore-CommerceOther Could you explain your type of company? Your Role in the Company Company Address Line 1 Company Address Line 2 City Region Postal/Zip Code Country Contact Number Email Address How did you hear about us? How did you hear about us?Web searchTrade ShowLocal RetailerOnline AdvertisementFrom a FriendOther How did you hear about us then? Any additional information? Submit
