Hello! Thank you for taking 2 minutes to fill this form in.
Looking forward to having you on board!
Phone Number
-
Area Code
Phone Number
E-mail
example@example.com
Would you like to set up a meeting?
Yes please.
No thanks, all good.
Customer Details
Full Name
*
First Name
Last Name
Business Name
*
Are you UK, EU or US based?
*
Please Select
UK
EU
USA
GST/VAT number (if applicable)
EORI number (if applicable)
Are you able to pay upfront via credit/debit card?
*
Please Select
Yes
No
Ordering & Delivery Info
Delivery Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Delivery Instructions? (please attached routing & packing guidelines)
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Ordering Contact Email Address
*
example@example.com
Ordering Contact Phone Number
Please enter a valid phone number.
Shipping Contact Email (if different)
example@example.com
Invoicing Details
Business Name. (This MUST be the legal business name that will appear on the invoice, but may be the same as the customer / retailer name listed at the start of this form)
*
Invoicing Email Address
*
example@example.com
Invoicing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What do you need from us? Is any invoicing set up required? (e.g. paperwork such as Flo letterhead, blank invoice, signatures needed, portal set up...)
You can also upload any supplier forms you need from us here, and we will get those back to you! Thank you.
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Did you contact us via Bloody Good Employer?
Please Select
Yes
No
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