Retail partner forms

Name *

First Name

Last Name

Business Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Office phone

Country

(###)

###

####

Mobile phone *

Country

(###)

###

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Product Segments *

In which of our product segments are you interested ?

General Merchandise

Health & Beauty

Sport & outdoors

Tools & Home improvements

All of them

Please do note that some of our partner brands can only be sold by specialized stores. *

I understand

I will require further clarification on this matter

Where are you selling your products ? *

Multiple choices allowed

In my store

On my own website

On global marketplaces

Please do note that some of our partner brands can only be sold in physical stores. *

I understand.

I will require futher clarification on this matter.

Please do note that some of our partner brands cannot be sold on marketplaces. *

I understand.

I will require further clarification on this matter.

Volume

How much do you plan on buying from LMD in the next 3 months in case you find what you need ?

0 - 5 000 €

5 000 € - 20 000 €

20 000 € - 50 000 €

50 000 € +

I don’t know.

Contact details of accounting manager

Leave empty if same as responsible person.

First Name

Last Name

Phone

(###)

###

####

Services

Are you also interested in our sourcing services ?

Yes

No

Maybe

Delivery information

I will handle the pick-up of the goods at LMD’s warehouse.

My logistics is handled by a third-party.

Same as business address.

Delivery address

Leave empty if same as business address.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact details for logistics manager

Leave empty if same as responsible person.

First Name

Last Name

Phone

Country

(###)

###

####

Do you need a truck with a hatchback ? *

Yes

No

Are your permises accessible for super trucks ?

Yes

No