Customer Application Form

Last Name: ^*
First Name: ^*
Company Name: ^*
Email: ^*

Address: ^*
Address 2:
City: ^*
Province: ^*
Postal Code: ^*
Country: ^*

Phone Number: ^*
Fax Number:
Toll Free:
Mobile Number:

Are you planning to open a new business selling tea, tea accessories or gift items? ^*
Do you currently operate a business selling tea, tea accessories or gift items? ^*
Are you currently a retailer of products other than tea? ^*
Are you planning to add tea and tea accessories to your product mix? ^*
What sort of business do you currently operate or plan on operating? ^*
Do you have a business licence number? (This could be an EIN#, Federal ID#, GST#, HST#, VAT#, Resale Licence# etc.) ^*
[Please note that due to various government regulations we will require this number with your opening order.]

Comments:
Security Code: ^*

* Required Field