Vaniggy Fashions / Go Girl

New Customer Details Form.

Nature of Organisation *
Business Name *
Trading As
Billing Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Shipping Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone
Fax
Mobile
Email
ABN (Australia Only)
Previous Address (if less than 2 years at current address)
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Contact Person for Orders Title First Last Suffix
Contact Person for Accounts Title First Last Suffix
Date Business Commenced / DD / MM YYYY
Preferred Payment Method Cheque / Bank Deposit (10% Discount) Credit Card (8% Discount) Frontline Member (5% Discount)
Preferred Payment Details

For Direct Deposit use account: Westpac Bank BSB: 034 136 ACC: 163 381 Otherwise please provide Credit Card Details or Frontline Membership Number here.
Marketing Information
How did you hear about Vaniggy Fashions / Go Girl ?
Tick below which best describes your business: Department Store Fashion Outlet Surf Shop Upmarket Boutique Tourist Shop Variety Store Franchisee Sports Store Gift Shop Chemist Newsagent Market Stall Other
Tick below which products are stocked in your store: Ladies Clothing Mens Clothing Childrens Clothing Swimwear Sarongs Hats Shoes / Thongs Jewellery Homewares Other
Best Selling Products in your store: