Janesce Stockist Application Clinic Name: Clinic Owner First Name: Clinic Owner Last Name: Clinic Email Address: Clinic Phone Number: Are you a qualified Beauty Therapist or is there a qualified therapist within the clinic? (required)* Yes, I am a qualified therapist Yes, there is a qualified therapist within the clinic No Clinic Physical Address for Delivery: Street Number, Name & Suburb: City: Region: Post Code: Clinic Postal Address (if different) The brand you are applying for today: janesce & bestow What product ranges does your clinic currently stock? What is your skincare philosophy? What appeals to you about Janesce? Clinic Owners Home Address: Owners Mobile number: Owners Personal Email: What is the best email address for newsletters to be sent to (specials, new product releases etc)? What is the best email address for account information to be sent to? What is the best email address for shipping information to be sent to? Send
