Application as Wholesale Client

In order to be entitled to receive our Wholesale Prices and our Special Offers
it is required that you provide us with the following information.

Once the form has been submitted we will contact you by email to finalise your application.
Information about yourself
All the Fields marked with • are required
• Business:
ABN:
• Name:
• Surname:
• Phone:
Fax:
Other Phone:
Home Phone:
Mobile:
• Email:
• Address:
• Town:
• State:
• Post Code:
Om Shantipi
Tel: (02) 6685 7461 - Intn'l: +61 2 6685 7461 - Mob: 0428 884 459 - Fax: (02) 6685 7481 - Intn'l: +61 2 6685 7481
P.O. Box 1110, Mullumbimby, NSW, 2482, Australia