WHOLESALE CLIENT INFORMATION

Primary Contact Name *

First Name

Last Name

Registered Company Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Delivery Address (if different)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Accounts Payable Contact *

First Name

Last Name

Amount of Credit Required *

< £1,000

> £1,000

Declaration *

By checking this box I declare that the information provided is true, that I hold a position in my company that permits me to provide such information, and that I agree on behalf of the company to the terms and conditions outlined on this website by KANPAI LONDON LTD.

I agree