LELO | Retailer Sign Up

Retailer Ordering System


REGISTER

Retailer Name :	*
USERNAME :	*
PASSWORD :	*
Language :

ADDRESS

Billing Address		Delivery Address
COMPANY :	*	COMPANY :	*
Corporate Reg. No. :
FIRST NAME :	*	FIRST NAME :	*
LAST NAME :	*	LAST NAME :	*
ADDRESS LINE 1 :	*	ADDRESS LINE 1 :	*
ADDRESS LINE 2 :		ADDRESS LINE 2 :
CITY :	*	CITY :	*
STATE / PROVINCE :	* Required for the USA	S STATE / PROVINCE :	* Required for the USA
POSTCODE/ZIP :	*	POSTCODE/ZIP :	*
COUNTRY :	*	COUNTRY :	*
TELEPHONE NUMBER :	*	TELEPHONE NUMBER :	*
EMAIL :	* Send newsletter ?
WEB :
Delivery address same as billing

COOPERATION INFORMATION

1. Type of your business ?		B2C B2B CO-BRANDING
2. Company status ? *		Existing Start up
( If start up, when do you start ? )
2.1 VAT number *
3. Your market *
( If other,please specify )

4. Business model ? *		Online Brick and mortar Both
4.1 Number of online shops *
4.2 Please write all web-shops URL's (separate with comma) *
4.1 Number of shops *
4.2 Average size (m2) *
4.3 Would you be interested in the LELO Display Solutions *
4.1 Number of online shops you distribute to? *
4.2 Number of regular shops you distribute to? *
4.3 Region/country you distribute to? *
4.4 Any other brand of similar products you are taking? *
5. Do you already stock LELO ?		Yes No
( If yes, you buy through )
( If other,please specify )

6. The countries you trade in :

7. Comments :


Please agree to the terms and conditions
I have read and agree to the TERMS AND CONDITIONS		I disagree