Wholesale Registration Form

Wholesale Registration Form

Fill out the information below to submit your request for a retailer account with Les Artisans d'Azure. We will review your request and send you more information upon your account's approval.

Company number*

Company name*

First Name*

Last Name*

Email*

Phone number*

Website URL

Company year of foundation

Shipping address

Address line 1*

Address line 2

City*

Province / State*

Zip code*

Country*

Type of company*

Please provide more information

Pictures of your store, kiosk, webstore, etc.

Share references of your other suppliers. (Share company names and addresses)*

Why do you want to become one of our retailers?*

Do you have questions or comments?