Wholesale Program Application

Please complete the information below (this form can be completed by selecting the appropriate box and typing in the information) and submit it to us by by hitting the "Submit your application" button.

Once we have reviewed the submited form and your application has been approved, we will then forward the appropriate wholesale information including product information sheets and wholesale price list.

Company Details

Name (First & Last) *
Company Name
Street Address *
Town / City *
Province / State *
Country *
Postal / Zip Code *
Telephone No. (inc country and area code) *
Fax Number (inc country and area code)
Email *
Company Website
Life Stage Of Your Company *

Additional Information

Product/s of Interest *
Worker ID Child ID Motorcycle ID Sport ID Medical ID Tech ID
Brief description of your business & products you currently carry *
Brief summary of your ideas / plans to market the Vital ID product/s that you are interested in *
Brief summary of your background & experience that would make you a sucessful reseller / wholesaler or stockist *
Please give an estimate as to the likely timescale that you would be in the position to purchase our product *
Terms And Conditions
CHECK BOX to indicate you accept our terms & conditions of sale