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Wholesale Application Form

Welcome to our new online wholesale website.

By filling in the form below you can apply for a "Surface Art" wholesale account online.

Simply choose a username and password and once we have activated your account you can login and order online at wholesale prices.

Once we've processed your request we'll send you an email activating your account, and detailing our wholesale terms and conditions and allowing you to login and order.

For wholesale enquiries in Victoria please contact:
Mandy Rush
Huxton Agency
Tel: 0432 683 696
email: mrush@huxton.com.au

For wholesale enquiries in South Australia please contact:
Rebecca Cichero
tel: 0422 794 656
email: staff@onesmallroom.com.au

The fields marked with * are mandatory.

Personal information
Title *
Name *
Last Name *
Company  
ABN Number (Aust.)  
Type of Business (required for wholesale)  

Billing Address
Address *
Address (line 2)  
City *
Federal State *
Country *
Postal code *

 

Contact Information
Phone *
E-Mail *
Fax  
Web site  
Username & Password

If you would like to become a member of our store, please fill in the Username and Password fields.

Your username should a single word containing only letters (lower or uppercase) and numbers, no punctuation can be used.

Signup for membership
Username *
Password *
Confirm Password *



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