New Reseller/Studio Application Form

Business details

Business/Company/School or Studio name:*

Address line 1:*

Address line 2:

Address line 3:

City:*

Postal/Zip code:*

Region/County:*

Country:*

Website URL:*

Email address:*

Contact telephone number:*

Company registration number (if applicable):

VAT registration number (if applicable):

Only applicable to UK and Europe

First name:*

Surname/Last name:*

Address line 1:*

Address line 2:

Address line 3:

City:*

Postal/Zip code:*

Region/County:*

Country:*

Email address:*

Mobile number:*

Are you the sole owner of the above mentioned business?*

If 'NO,' please state the name of all other business owners/partners/directors

Do you currently purchase any of your pole and/or aerial equipment from any other manufacturer?*

If 'YES,' please state the manufactures:

How long have you been involved in the pole and aerial fitness industry?

How did you hear about X-POLE?

Please detail how you will promote and sell X-POLE products*

For example, do you have a website, a physical store or studio/gym location?

Please provide any further information which you think will assist us in setting up a new trade account for you:

Please type your name here:*

Typing your full name here means that you have agreed to release your details to X-POLE and agreed to abide by our Terms & Conditions.

Terms & Conditions

By ticking this box, I agree to the terms & conditions as detailed here: http://x-pole.co.uk/shopping-terms/