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WHOLESALER APPLICATION FORM

If you would like to apply to distribute or resell our disposable hygienic products please complete the following
information as fully as possible and one our staff will reply usually within 48 hours after reviewing your application.

STEP 1

Please provide some contact details:

Contact Name
             Company Name


Company Address 1


Company Address 2


Company Address 3


County
       Postcode
         Country

Telephone
               Fax

E-mail address

Type of Business
           Website Address


STEP 2

Please select the products you are interested in

Consumer Products
      Cleanseat Dispensers and Refills    All Products


STEP 3 (UK Only)

Please provide one of the following company details or fax your company letterhead to 0870 881 0582

Company Registration Number
 Company VAT Number


STEP 4

Please make any comments or detail approximate quantities