Thank you for your interest in our range of Kawakawa Products.

Our wholesale customers are important to us, as this broadens our ability to promote our Kawakawa products further afield, thus providing the customer with more purchasing options. 

If you would like to open a Wholesale Account, please fill out the Application Form below.

We will get you registered as soon as possible. To do this we will need all requested business information before we can process your request. We may phone or email you to confirm the details on your application.

If you are requesting monthly account credit facilities you must give at least TWO references (names and telephone numbers) in the appropriate box. Thank you.

* Required

Title DR MISS MR MRS MS

First Name *

Last Name *

Company *

Work Address *

Town/City *

Region/State *

Postcode/Zipcode *

Country * -- Select Country -- AUSTRALIA NEW ZEALAND UNITED KINGDOM UNITED STATES

Email Address *

Confirm Email Address *

Password *

Confirm Password *

Work Phone Number *

Cell Phone Number

Work Fax Number

Home Phone Number

Web Address

Preferred Payment Method * Internet Banking Credit Card (PayPal) Cheque Monthly Account

Reference #1 (Monthly Account Applications only)

Reference #2 (Monthly Account Applications only)

Enter Word Verification in box below *

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