/ Stockist Registration

NEW STOCKIST REGISTRATION

While the Willow brand is still a growing one, we remain particular on who we supply our products to. This is because the public deserves to be well-informed and receive the best possible advice, coupled with the right product for their needs.

For this reason, new stockist registrations are subject to approval.

If you believe you have the necessary qualifications and experience to confidently recommend our products, please continue by completing the below form, as well as submitting a copy of your ID and relevant certification. Only once we have all this information, will our sales team be in touch:

Business/Practice Name:

Business Type: Health Shop Practitioner

VAT Number:

Website Address:

Contact Person

Title:

First & Last Names:

Tel Number:

Email Address:

Billing Address

Street Address:

Suburb:

City:

Province:

Postal Code:

Country:

Where did you hear about us?

Delivery Address

Delivery address is the same as billing address

Street Address:

Suburb:

City:

Province:

Postal Code:

Country:

Background Information:

Documentation: Please provide us with a copy of your ID and certificates of your qualifications.

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