Alex Dunae <p>Thank you for your interest in the <strong>daisychain</strong> collection of designer maternity support belts. At present time we are accepting<br /> applications for brick and mortar and on-line stores.</p> <p>Please read our <a href="/pages/wholesale-policies">wholesale policies</a> before filling out your application.</p> <h3>Wholesale Application Form</h3> <p><br /> <form method="post" action="http://dunae.ca/dcmail.php" id="wholesale_form"></p> <label for="store_name">Store name</label> <input type="text" name="store_name" id="store_name" class="text" /> <label for="store_address">Store address</label> <textarea name="store_address" id="store_address" class="bigtext"></textarea> <label for="shipping_address">Shipping address (if different)</label> <textarea name="shipping_address" id="shipping_address" class="bigtext"></textarea> <label for="contact">Contact (name/position)</label> <input type="text" name="contact" id="contact" class="text" /> <label for="store_url">Store <span class="caps">URL</span></label> <input type="text" name="store_url" id="store_url" class="text" /> <label for="email">Email Address</label> <input type="text" name="email" id="email" class="text" /> <label for="phone">Phone</label> <input type="text" name="phone" id="phone" class="text" /> <label for="mobile">Mobile</label> <input type="text" name="mobile" id="mobile" class="text" /> <label for="fax">Fax</label> <input type="text" name="fax" id="fax" class="text" /> <label for="business_description">Description of business (brick and mortar/on-line/other-describe?)</label> <textarea name="business_description" id="business_description" class="bigtext"></textarea> <label for="business_type">Single location/franchise/chain/department store?</label> <input type="text" name="business_type" id="business_type" class="text" /> <label for="business_age">How long have you been in business?</label> <input type="text" name="business_age" id="business_age" class="text" /> <label for="other_maternity_brands">Do you presently carry any other maternity support garments?</label> <input type="text" name="other_maternity_brands" id="other_maternity_brands" class="text" /> <label for="referral_source">How did you hear about <strong>daisychain</strong>?</label> <input type="text" name="" id="" class="text" /> <label for="sell_online">If you are a brick and mortar store, do you also sell on-line?</label> <input type="text" name="sell_online" id="sell_online" class="text" /> <label for="other_information">Any other information you feel we should know?</label> <textarea name="other_information" id="other_information" class="bigtext"></textarea> <p>I certify that all information contained herein are true and I have read the <a href="/pages/wholesale-policies">wholesale policies</a> provided.</p> <label for="signature">Please type your name here as your signature</label> <input type="text" name="signature" id="signature" class="text" /> <div id="application_submit"> <input type="image" src="http://static1.shopify.com/s/files/1/0025/9652/assets/submit.png?1233117565" value="Submit" /> </div> </form> <p><notextile></p> 2009-01-27T20:38:51-08:00 wholesale-application 3082862 2009-01-27T20:38:51-08:00 259652 2009-09-12T16:18:01-07:00 Thank you for your interest in the *daisychain* collection of designer maternity support belts. At present time we are accepting applications for brick and mortar and on-line stores. Please read our "wholesale policies":/pages/wholesale-policies before filling out your application. h3. Wholesale Application Form <notextile> <form method="post" action="http://dunae.ca/dcmail.php" id="wholesale_form"> <label for="store_name">Store name</label> <input type="text" name="store_name" id="store_name" class="text" /> <label for="store_address">Store address</label> <textarea name="store_address" id="store_address" class="bigtext"></textarea> <label for="shipping_address">Shipping address (if different)</label> <textarea name="shipping_address" id="shipping_address" class="bigtext"></textarea> <label for="contact">Contact (name/position)</label> <input type="text" name="contact" id="contact" class="text" /> <label for="store_url">Store URL</label> <input type="text" name="store_url" id="store_url" class="text" /> <label for="email">Email Address</label> <input type="text" name="email" id="email" class="text" /> <label for="phone">Phone</label> <input type="text" name="phone" id="phone" class="text" /> <label for="mobile">Mobile</label> <input type="text" name="mobile" id="mobile" class="text" /> <label for="fax">Fax</label> <input type="text" name="fax" id="fax" class="text" /> <label for="business_description">Description of business (brick and mortar/on-line/other-describe?)</label> <textarea name="business_description" id="business_description" class="bigtext"></textarea> <label for="business_type">Single location/franchise/chain/department store?</label> <input type="text" name="business_type" id="business_type" class="text" /> <label for="business_age">How long have you been in business?</label> <input type="text" name="business_age" id="business_age" class="text" /> <label for="other_maternity_brands">Do you presently carry any other maternity support garments?</label> <input type="text" name="other_maternity_brands" id="other_maternity_brands" class="text" /> <label for="referral_source">How did you hear about <strong>daisychain</strong>?</label> <input type="text" name="" id="" class="text" /> <label for="sell_online">If you are a brick and mortar store, do you also sell on-line?</label> <input type="text" name="sell_online" id="sell_online" class="text" /> <label for="other_information">Any other information you feel we should know?</label> <textarea name="other_information" id="other_information" class="bigtext"></textarea> <p>I certify that all information contained herein are true and I have read the <a href="/pages/wholesale-policies">wholesale policies</a> provided.</p> <label for="signature">Please type your name here as your signature</label> <input type="text" name="signature" id="signature" class="text" /> <div id="application_submit"> <input type="image" src="http://static1.shopify.com/s/files/1/0025/9652/assets/submit.png?1233117565" value="Submit" /> </div> </form> <notextile>