Reseller Application Form

Reseller Application

Account Application Form

Fields marked with an * are required

Billing Address


Delivery Address (If Different from Billing Address)


Banker Information



INITIAL, 2nd AND 3rd ORDERS TO BE PRE-PAID IN FULL
SUBSEQUENT ORDERS WILL BE PLACED ON ACCOUNT (CONDITIONS APPLIED)
MAXIMUM CREDIT LIMIT IS AU$3,000
ACCOUNTS STRICTLY 30 DAYS FROM DATE OF INVOICE

By Submitting this form
I/We declared the above information to be true and correct; I/We authorised Blossoms BH Wholesale Pty Ltd to check the references given on my/our credit and financial responsibility.