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Step 1 of 2

What is the name of the company?

Peles Select your Business Type

What is the name of the main owner?

What is the name of the shop?

What is the shop address?

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

What is the name of the second owner?

Are you operating as a company or a sole trader?

How many retail outlets do you have?

What is the full residential address of the principal director/owner?

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

What is the VAT number?

What is the company registration number?

How many years of trading experience do you have?

What are the shop opening times?"

Phone

How Did you Find Us or Sales Rep. Name

Please Select Purchase Option

If directed by our sales representatives, please provide their name. For online purchases, select the Online Sale

File Upload

Click or drag a file to this area to upload.

Please provide the name and signature of the company director.

I hereby declare that the information provided above is true and complete. Additionally, I understand that any intentional misrepresentation may lead to the rejection of my application.