Customer Application Form
Last Name:
*
First Name:
*
Company Name:
*
Email:
*
Address:
*
Address 2:
City:
*
Province:
*
-None Selected-
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
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?
*
Yes - Immediately
Yes - 1 month
Yes - 2-3 months
Yes - 3-4 months
Yes - 5 months +
No
Do you currently operate a business selling tea, tea accessories or gift items?
*
Yes
No
Are you currently a retailer of products other than tea?
*
Yes
No
Are you planning to add tea and tea accessories to your product mix?
*
Yes - Immediately
Yes - 1 month
Yes - 2-3 months
Yes - 3-4 months
Yes - 5 months +
No
What sort of business do you currently operate or plan on operating?
*
Bed & Breakfast
Cafe
Coffee Roaster
Distributor
Gift Baskets
Gift Store
Hotel
Ingredients - Manufacturing
Instore Bakery & Cafe
Internet Sales
Personal Requirements
Promotional Items
Restaurant
Souvenir Sales
Spa & Wellness
Tea Room
Tea Store
z-Other Food Service
z-Other Manufacturing
z-Other Retail - Store
z-Other
Do you have a business licence number? (This could be an EIN#, Federal ID#, GST#, HST#, VAT#, Resale Licence# etc.)
*
Yes
No
[Please note that due to various government regulations we will require this number with your opening order.]
Comments:
Security Code:
*
* Required Field
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Erica Lahoda Web Girl