Export Enquiry Form - Laval Cosmetics

Export Account Application

Business(*)

Invalid Input

Business Name(*)

Invalid Input

Company Name

Invalid Input

Trade(*)

Invalid Input

Years Trading(*)

Invalid Input

Number of Employees(*)

Invalid Input

Business Address

Registered Address(*)

Invalid Input

Delivery Address

Invalid Input

E Mail(*)

Invalid Input

Website Address

Invalid Input

Telephone Number(*)

Invalid Input

Proprietor or Director Details

Proprietor/Director Name

Invalid Input

Proprietor/Director E Mail

Invalid Input

Proprietor/Director Address

Invalid Input

Freight Forwarder Details (If Known)

Address

Invalid Input

Company Name

Invalid Input

E Mail

Invalid Input

Contact Name

Invalid Input

Phone Number

Invalid Input

Sales/Account Information

Accounts Contact Name(*)

Invalid Input

Contact E Mail(*)

Invalid Input

Est Monthly Spend(*)

Invalid Input

Current Annual Turnover(*)

Invalid Input

Currently Sell Laval?

Invalid Input

Trade References

Please provide details of 2 referees

Reference 1

Full Name

Invalid Input

Company Name

Invalid Input

E Mail

Invalid Input

Phone

Invalid Input

Address

Invalid Input

Reference 2

Full Name

Invalid Input

Company Name

Invalid Input

E Mail

Invalid Input

Phone

Invalid Input

Address

Invalid Input

Declaration

I have read and agree to your terms and conditions of sale. I confirm that by submitting this form I am electronically signing this agreement on behalf of the company stated above.
I agree to any credit searches and references to be made with the details I have provided above. I understand that my application may be rejected if I do not provide the full information or make a false declaration. I agree that Laval Cosmetics can use this information in order to provide me with goods, services and communication.

Invalid Input