Wholesale Registration Form

Complete the form below if you're interested in offering our products to your customers.

password (required)

re-type password (required)

first name (required)

last name (required)

company (required)

role

contact number (required)

e-mail (required)

company web site

VAT (if applicable)

address (required)

street address

address line 2 (OPTIONAL)

city

state (OPTIONAL)

postal code

Delivery ADDRESS (required)

Same as physical

street address

address line 2 (OPTIONAL)

city

state (OPTIONAL)

postal code

I want to sign up to Elite Shungite newsletter

any additional information

You’re nearly done!

There’s always terms and conditions when you sign up for a new service - these protect both us and you, so they’re worth a read.

Download the Terms and Conditions in a PDF format Privacy Policy

I have read and agree to the terms and conditions