New Reseller Application Form

Reseller application

If you have a dance school, gym or studio, you would be entitled to receive a discount on products for your organisation. Please complete all the fields marked with an asterisk*. Incomplete or incorrectly completed forms will only slow down the process in setting up your account.

Business details
Company/School/Studio name:*
Address line 1:*
Address line 2:
Address line 3:
City:*
Postal/Zip code:*
Region/County:*
Country:*
Website URL (if available):
Email address:*
Contact telephone number:*
Company registration number (if applicable):
VAT registration number:
Only applicable to UK and Europe
Personal details
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?*
- YES
- NO
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?*
- YES
- NO
If 'YES,' please state the manufactures:
How long have you been involved in the pole and aerial fitness industry?
- Less than 1 year
- 1-2 years
- 3-4 years
- 4+ years
How did you hear about X-POLE?
- Referred by a friend
- Website
- Newsletter
- Exhibition/Event
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/

New Reseller Application Form

Reseller application

Business details

Personal details

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