Wholesale Request Form

Wholesale Application:
Welcome! We are so happy you've found us. We are always looking for unique and incredible businesses like yours to join our team of stockists.

There are a few things we would like you to know before filling out this form:
- Our minimum spend per order is $500 after discount
- If you place consistant orders we have exclusive zoning to ensure you get the maximum benefit from our products (this is dictated by population and density)
- Images and marketing material can be provided for all ordered products
- You must be the ABN holder or have approval from the ABN holder to request a wholesale account
Full Name*

First NameLast Name
Company Name *
ABN*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Where do you sell your product?*
Why do you want to be a Country Allure stockist:*
How did you hear about us?*
Should be Empty: