Wholesaler Application Form Please enable JavaScript in your browser to complete this form.1. About You1. About YouTakes about 2 minutes. We'll use this to prepare wholesale pricing that suits your business.Your Name *FirstLastBusiness / Trading Name *Your RoleEmail Address *Cell / WhatsApp Number *Town / City *Province *GautengWestern CapeKwaZulu-NatalEastern CapeFree StateLimpopoMpumalangaNorth WestNorthern CapeOutside South Africa2. Your Business2. Your BusinessWhat type of business are you? *Medical practice / clinic / hospitalDental practicePharmacyBeauty, nails, aesthetics or salonTattoo or piercing studioRestaurant, catering or food productionButchery or deliCleaning / janitorial companyFuneral home or mortuaryOld-age home / frail care / home-based careIndustrial, manufacturing or workshopRetail shop / resellerDistributor / wholesalerSchool, NGO or governmentOtherPlease describe your businessType of entitySole traderPartnershipPty LtdClose Corporation (CC)NPO / otherVAT Number (if registered)How long have you been trading?Just starting outLess than 1 year1–3 years3–5 yearsMore than 5 yearsWebsite or social media page3. What You're Looking For3. What You're Looking ForAre you buying to use or to resell? *Bulk buying for use in my own businessReselling to my customersBothWhere will you resell?My own shop / pharmacyOnline storeMarkets / informal tradeTo other businesses (B2B)ExportWhich products are you interested in? *Gloves (nitrile, latex, surgical, household)Masks & respiratorsProtective clothing (PPE)Medical consumablesSterilisation pouches & alcohol swabsWipes & cleaningPaper products (wiper rolls, towels)Till rolls & POS paperWaste & disposal bagsPersonal care & incontinenceSpecific products, sizes and quantities *Estimated spend per month *Under R2,000R2,000 – R5,000R5,000 – R15,000R15,000 – R50,000R50,000 – R100,000Over R100,000How often would you order? *WeeklyEvery 2 weeksMonthlyEvery few monthsOnce-off bulk orderTarget price you're looking to pay (optional)Do you currently buy these products from another supplier?YesNo – this is new for usWhat would make you switch to Glove SA?Delivery or collection? *Delivery to my businessCollect from your Sandton warehouseEitherWould you need credit terms?No – I'll pay upfront (EFT/card)Yes – I'd like to apply for a 30-day account4. Staying in Touch4. Staying in TouchPreferred way to contact you *Phone callWhatsAppEmailHow did you hear about us?Google searchFacebook / InstagramReferral from someoneExisting customerSaw your delivery van / premisesOtherAnything else we should know?Privacy *I agree that Glove SA may store and use my details to process this application and contact me about my enquiry (POPIA).Specials & new productsYes, send me wholesale specials and new product updates (unsubscribe anytime).Submit Wholesale Application
