Registration Form

Step 1

Retailer Registeration Form

Tell us about your business so we can grant you access to wholesale pricing and ordering

Name of Owner/Director

Trade Name

ABN / Business Registeration Number

Business Website

Business Name

Business Email

Business Type

Personal Details

First Name

Personal Email Address

Last Name

Phone Number

Business Address

Street Address

State

Country

City

Post Code

Communication Method (Multi-select)

Delivery Requirement

Special Delivery Instructions if any including trading hours

Trade Reference: Company name 1

Trade Reference: Company Contact Phone / Email 1

Trade Reference: Company name 2

Trade Reference: Company Contact Phone / Email 2

Comment or Message

Create YourPassword

Choose the password you'll use to sign in

Password

Confirm Password

By submitting the form, you agree to *

✓ All accounts are on a prepayment basis.
✓ Claims arising from invoices must be made within 2 days of delivery.
✓ Delivery charges may apply.
✓ You authorise Fuddlr to make inquiries into trade references that you have supplied.
✓ The Retailer acknowledges and agrees that the Products supplied under this agreement are intended for re-sale within Australia.
✓ The retailer agrees that the product will only be sold under the registered business name or trade name.

Apply To Stock Our Brand

Retailer Registeration Form

Retailer Registeration Form

Personal Details

Business Address

Communication Method (Multi-select)

Operation Platform

Delivery Requirement

Create YourPassword

By submitting the form, you agree to *

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Apply To Stock Our Brand

Retailer Registeration Form

Retailer Registeration Form

Personal Details

Business Address

Communication Method (Multi-select)

Operation Platform

Delivery Requirement

Create YourPassword

By submitting the form, you agree to *

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