Registration - StarlingSA

Username *

User Email *

User Password *

Confirm Password *

Name of Business: *

Trading Name (if different from Name of Business):

No of retail stores:

Owner/Director: *

Person responsible for account - Email *

Person responsible for account - Phone No *

Person Who Will be placing orders - Email

Person Who Will be placing orders - Phone No

Delivery Address (if different from Business address):

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Account Type: *

If 30 Day account applied for then please provide 2 trading references

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Would you allow your business to be viewed on our website as a resller of our products? *

Would you allow your business to be viewed on our social network platforms as a resller of our products? *

If you answered YES to either of the above please complete next line (to be displayed). Please indicate Name of business to be displayed, Suburb, Province, Contact number OR email

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