New Distributor Registration

Please fill out the form below. Once your application is approved you will be supplied with a username and password to login to our website.

* Fields are compulsory
Business Name:	*
Contact Person:	*
Description of Business:	*
Describe the operation of your business in 50 words:	*
Telephone No.:	()* (Please supply a landline number)
Fax No.:	()
Cellular No.:
VAT Registration No.: (If applicable)
Email Address:	*
Physical Address:	*
Area/Suburb:	*
Code:	*
Postal Address:
Postal Code:
Website Address:
Do you own a retail shop?:	Please select Yes No *
Please send me special offers and newsletters:
PLEASE TAKE NOTE: The discretion to register you lies with the Directors of Wilson and Maclagan as we cannot allow trading to too many shops in certain areas. Therefore you will not receive a login code and password immediately. There is a waiting period of 3 or more days.