PSU Wholesale Agent Form

PACIFIC SEA URCHIN AUSTRALIA

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Agent Form

Agent Form

Please fill in the form below for agent registration with Pacific Sea Urchin (AUS) Pty Ltd

* Indicates required field

First Name *

Last Name *

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Company Name *

Company ABN *

Are you currently selling sea urchin? If yes, please provide current sea urchin provider/company. *

If none, please write "None"

Do you do group sale on social media? Please provide the group name in the next question. *

Yes No

Do you do group sale on social media, please provide the group name. *

If none, please write "none"

What type of sea urchin you looking for? *

Long Spine Purple Sea Urchin Long Spine Red Sea Urchin Long Spine Black Sea Urchin Short Spine White Sea Urchin Short Spine Black Sea Urchin Short Spine Yellow Sea Urchin

What grade of sea urchin you looking for? *

Super Premium 8A Sea Urchin 100g Super Premium 8A Sea Urchin 50g Premium 5A Tassie Sea Urchin 100g Sushi Grade 5A 100g Sushi Grade Tassie 50g Mixed A&B Sea Urchin 200g Mixed A&B Sea Urchin 100g Boston Trays Tassie Uni 90g Mixed A&B Sea Urchin 90g Ensui Sushi Premium 5A 125g Kina NZ style 100g Kina NZ style 150g

How often you like to place order? *

Weekly Occasionally Monthly

Your preferred payment method *

7 Days Credit Term Direct Deposit Credit Card

7 days credit term requires additional documents to apply

Quantities to order? *

10 30 50 70

Do you have cold room , fridge or suitable storage? *

Do you have shop? *

Yes No

If yes? Pls describe what shop? *

Why would you like to become our distributor? *

Submit

Pacific Sea Urchin Home
Products
The Sea Urchin Story
- Recipe
Uni Boom Boom
- Menu
- 10000 Bowls Giveaways
Contact
- FAQ
Agent Form