Wholesale Enquiries

Your Name & Surname (required)

ID Number

Registered Business Name

Business Trading Name (required)

Business Type, ie. Supermarket, Deli, Farmstall, etc. (required)

Company Registration Number

VAT Number

DELIVERY ADDRESS:

Address Line 1 (required)

Address Line 2 (required)

City (required)

Province (required)

Postal Code (required)

ACCOUNTS DEPARTMENT:

Name of Person Responsible for Accounts (required)

Contact Number for Accounts Department(required)

E-mail of Person Responsible for Accounts(required)

I, in my capacity as an authorised representative of the applicant, hereby record that by signing this application form I agree to provide surety in respect of any of the applicant's obligations to Lavender & Lime incurred hereafter. By checking this box I agree with the above statement.

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