Retailer application

Contact us by using this form, if you would like to become one of our Milledeux’s select retailers. Milledeux reserves the right to decline retailer requests.

Application form

Contact name (required)

Company name (required)

Company website (required)

Billing address (required)

Shipping address (required)

Contact email (required)

Contact telephone number (required)

Company registration number / tax ID (required)

Ecommerce shop or physical shop (required)
Ecommerce shopPhysical shop

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