Tel: (905) 212-9883
Fax:  (905) 212-9885
Email: victorianaimports@gmail.com
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Wholesale Account Registration Form

Company name: *
Contact name: *
Contact phone number: *
Fax number: *
Email address: *
. Note: The Email Address is used as Login ID

Store address: *
Address (cont')  
City: *
Country: *
Province/State: *
Postal Code/Zip Code: *
Store phone number: *
Store website:  

Business Registration Number:: *
  Note: For Canadian customers only.
Federal Tax ID Number: *
  Note: For US customers only.
* denote mandatory field