Trading Name of Business *

ABN *

First Name *

Last Name *

Position

Business Owner

Accounts Contact *

Accounts Phone *

Email *

Phone *

Address Line 1 *

Address Line 2 *

City *

State/Prov/Region *

Postal/Zip *

Country *

Instagram *

Website *

Online only
Retail Shop
Interior Designer/Stylist

Architect
Property Stylist
Wholesaler

Trade Reference 1

Contact Person

Phone

Trade Reference 2

Contact Person

Phone

Signature *

Title *

Print Name *

Date *

Thanks for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

By submitting this application, I, the undersigned, certify that all the information on this application is true and accurate to the best of my knowledge. In addition, I, the undersigned, understand that the wholesale agreement is strictly offered to customers intended to resell Boem products, and Boem reserves the right to reject this applications or terminate it at anytime.This application does not grant credit terms. Boem does not extend credit terms, all orders and invoices are supplied under pro forma terms only.

Thanks for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

Currency

BOEM LINEN

The Marquee Shift Dress- Linen