International Retailer Application

Thank you for your interest in pediped™ footwear. pediped™ does not currently accept applications from consignment stores or stores that sell used goods.

Please take a few minutes and fill out this online application.  You will be notified once you are approved. 

If you have any questions regarding the status of your application, please contact customerservice@pediped.com.

* First Name:		* Last Name:
* Store Name:		* VAT#:

	All international accounts require a VAT number.  If you do not have a number please type N/A and explain why in the box below:

* Email:		* Confirm Email:
Website URL:
* Phone #:		Fax #:

Mailing Address
* Address:
* Country:

* Type of Retailer:

Choose one Brick & Mortar Store Online Retailer Both (Brick & Mortar Store AND Online Retailer)

* Merchandise:	NewConsignment/UsedBoth
* Price Range of Merchandise:	Choose one low low to medium medium medium to high high
Describe your store
* Location:
* Clientele:
* Décor:
* Size (sqm):
Other Details:	The more you can describe your store in detail, the better it will assist us in approving your application.

* Is your store currently open?

Yes No

* If yes, how many years has it been established?

< 1 1 2 3 4 5 6 7 8 9 10+ 15+ 20+ 25+ 30+ 50+ < 1

If no, when do you plan on opening? (MM/YYYY)

* How many (brick & mortar) store locations do you have?	1 2 3 3 5 6 7 8 9 10+
Name 3 brands that you carry or plan to carry.
* Brand 1:
* Brand 2:
* Brand 3:
* Other Brands:

How did you hear about us?
Trade Magazine (s):		Msc: Sales Rep/Showroom Rep Web Search Customer Friend/Relative
Consumer Magazine (s):
Trade Show:
Other:

Comments or Questions:
By submitting this application, you agree that you have read our wholesale policy and agree to the terms outlined. Customers who sell below MSRP or auction sites, such as ebay will not be shipped again. Click here to read our wholesale policy.