Wholesale Request Form

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Please complete this form to indicate your interest in becoming a Body Matters Gold Wholesaler.

Once the form is completed we run a couple of simple checks to verify that you are a business entitled to wholesale rates.

If approved, you will receive a username and password within 48 hours.

With your unique username and password you can access the wholesale online ordering system.

Required fields are marked with an *

Personal Information

Salutation: Mr, Mrs etc.*
Full Name:*
Company Name:*
Position in Company:*
Company Address:*
Town/City:*
County/State:*
Postcode/Zip Code:*
Country:*
Telephone No:*
Fax Number:
E-Mail Address:*
Number of Employees:
Choose a Password:*	4 characters+
Shipping Information
If your shipping address is different to above, please tick this box and fill in below
Shipping Address:
Town/City:
County/State:
Postcode/Zip Code:
Country:
Please give us a brief description of the type of shop or business you have.

Write YES in this box only if you have read and agree to abide by the Terms & Conditions of becoming a wholesaler for BMG. If you do not fill in this box your application will not be accepted.