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Registration for traders and retailers

Please fill in the form in order to have trader-access to www.polyglobemusic.com.
* indicates mandatory field.

Company data
Company name *
Manager's first name *
Manager's surname *
Owner's first name *
Owner's surname *
Street *
Postal Code *
Place *
State *	Austria
Phone *
Fax
Mobile/cellular
eMail *
Homepage
UID number *
Field of trade *
Choose only one, if more opportunities apply, please tick your main field of trade.
	CD trade
	Book trade
	Esotericism trade
	Hotel
	Pharmacy
	Therapy/institute
	Others
Where do you sell your products to your customers?
	Street shop
	Therapy - wellness - area
	Mail - order firm
	Homepage
Which suppliers in the industry do you already cooperate with?

Which of our products are relevant for you? *
	CDs
	Books
	Sound goods
	Tibetica
Contact
Contact for order information *
Contact for our accounts department *
Which of our online-portals would you like to get retailer-access to? *
	www.polyglobemusic.com
	www.klangmassage.at
Customer number	(if you have already received a customer number from PolyglobeMusic)
Your log in
Enter a username * (at least 6 characters)
Enter a password * (at least 6 characters)
Password confirmation *

*	I confirm that I have read, understood and accept the conditions of use and sale set out on this website.
*	I send a copy of my trading licence to PolyglobeMusic Austria (Fax-Nr.: + 43 (0) 512 / 37 00 77-33).
Note: Following a successful registration, you will receive an e-mail containing your access-details. We will be sending this e-mail in HTML format (default). If you would rather receive a text-mail, deactivate the control-box below.
	Send me the e-mail containing my access details in HTML format.

	Username
	Password
		Register now

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