Retailers Form Fill | Hegemonic Support team

RETAILERS FORM - WORLD ORDER PLEDGES

Please fill in the form below so that we can include your details in our Pledge Manager.

As soon as your application is approved (usually within 24 hours from submitting) you can finalize your retailer pledge.

(all items marked with an asterisk (*) are required)

Company Name:

Store Phone Number:

Your Preferred Email: *

Please use the same email as the one that you will use to access the PM

Store Representative: *

Store website url:

Store Address: *

Address Line 2:

City: *

Zip Code: *

Tax ID: *

Please enter your Tax ID - or VAT number if in EU.

Country: *

Subject: *

Your Request Here: *

Please give us an indication for how many and which pledges you are interested.

Store Validation:

Please upload a Photo of your store, Company registration number or other proof of business.

Submit