Join as a Wholesaler | Adora Handmade Chocolates

Wholesaler Application

Please complete all sections of the information from and read thr Terms and Conditions of Trade overleaf or attached.

Customer’s Details:

Individual

Sole Trader

Trust

Partnership

Company

Other

Name*

Physical Address *

Billing Address *

Email*

Phone *

Fax No *

Mobile No *

Personal Details:

(please complete if you are an Individual)

Date*

Drivers Licence No *

Business Details:

(please complete if you are a Sole Trader, Trust, Partnership, Company or Other – as specified)

Trading Name *

ABN*

ACN*

Contact Person: *

Phone No*

Nature Of Business*

Directors / Owners / Trustee:

(if more than two, please attach a separate sheet)

(01) Full Name*

D.O.B.*

Physical Address**

Driver’s Licence No*

Phone No*

Mobile No*

(02) Full Name*

D.O.B.*

Physical Address*

Driver’s Licence No*

Phone No*

Mobile No*