Become a Registered Retailer
General Info
Company Name
Contact Name
Daytime Phone
Cell Phone
E-mail Address
Web Site
Shipping Address
Street
Street 2
Postal / ZIP Code
State / Province
Country
Billing Address (if different from shipping address)
Street
Street 2
Postal / ZIP Code
State / Province
Country
For British Columbia Businesses
PST #
About Your Store(s)
Store Name
Will Zufall be in multiple locations? If yes, please indicate each store name and address.
Would you like your retail location(s) to be listed on our website?
Yes
No
Shipping
Standard shipping for Zufall 10 packs through Canada Post is $20.00 per pack. If you do not want to use Canada Post you may use a prefered shipper by providing the necessary information below.
Prefered Shipper
Payment Preference
Send C.O.D. via selected shipper
Carge to my shipping account #
Have shipper charge my credit card
Shipper Account #
Please have shipper bill my credit card
Select card
VISA
MasterCard
Credit Card Number
Expiration Date
Name on Card