To become a distributer of Urbanity and recieve a wholesale price list please complete the form below.

Contact Person

Title: *
First Name: *
Last Name: *

Company Details

Company Name: *
Company Address: *
Company Phone Number: *
Company Email Address: *
Website Address:
No. of Years in Business: *
Company Registration Number:
VAT Number:
How will you be selling Urbanity products? *

Enquiry (Please give a brief description of your business and why you would like to become a distributor of Urbanity products. *