Retail customer or clinics details
Get listed as a retailer or clinic on our locator.
We need some details about your business. We use this information to list you on our locator, so please ensure it is accurate. Please call 08 9379 3400 if you have any questions.
Name
*
First Name
Last Name
E-mail
*
You must make regular purchases of RockTape to be listed on our locator.
I purchase from
*
Altmans
JMA
Cozmic
Perth Health Foods
Club Warehouse
Pronat
ITA Wholesale Distribution
Australian Physiotherapy Equipment
Alpha Sport
Briggate
Practitioner Supplies
Orthologix
Compass Distribution
Other
Retail or clinic name
*
For example Priceline Floreat Forum or Floreat Physiotherapy
Retail or clinic phone number
*
Retail or clinic address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Submit
Should be Empty: