Trade Account Application

Business Details

Full Legal Name of Reseller *

Trading Name (if different)

Posting / Billing Address *

Posting / Billing Address Postcode *

Physical Address & City *

Physical Address Postcode *

Primary Contact

Primary Contact Person *

Position *

Phone *

Email *

Mobile

Direct Dial

Billing Contact

Business Billing Contact Name *

Business Billing Email *

Details of Persons Able to Make Financial Decisions on Behalf of the Business

Manager / Owner / Director / Partner

Merry Christmas & Happy New Year from the Reterniti Team! Final kits ship 22 Dec 2025. Ashes received after 24 Nov will have Stones dispatched from the week of 5 Jan 2026.