Online Application as a Retailer

Apply here as a retailer. The form below must be completed before you order anything from Tish’la Anne Kirby®. You will notified if your application is successful.

Application as a Retailer

1. Your Name(required)
2. Company Name(required)
3. Email(valid email required)
4. Contact Number(required)
5. Full Business Name and Trading Name(required)
6. Province KZN Gauteng Free State The Eastern Cape Limpopo Mpumalanga The Northern Cape North West The Western Cape (required)
7. Business Registration Number(required)
8. AddressPlease enter your full business address(required)
9. Would you like a copy of this application?
10. Security Code

 

cforms contact form by delicious:days

The application form is for pet shops that wish to stock our products and buy it in bulk. A price list will only be sent upon a successful application.