A2Z Creams And Coffee Apliances Limited

Distributor & Wholesale Complience Form

Section 1 — Business Information

Company Or Trading Name (Provide Both If Different):

1. Business Structure:

Limited Company

Sole Trader

Partnership

Other

2. Company Registration Number

3. Company VAT Number:

4. Business Trading Address:

5. Business Website or Trading Platform:

Section 2 — Authorised Purchaser & Identity

6. Full Name of Authorised Purchaser:

7. Position Within the Business:

8. Business Email Address:

9. Contact Telephone Number:

Age & Authority Declaration: I confirm that I am aged 18 or over and am authorised to purchase on behalf of the business.

10. Please provide a copy of your driving license or passport for identity verification purposes using the link below.

Upload your file

Choose a file or drag and drop one here.

11. Provide appropriate evidence of trading, such as a company registration document, business invoice, trading website or business registration evidence for sole traders.

Upload your file

Choose a file or drag and drop one here.

Section 3 — Intended Use & Wholesale Distribution

12. What is the intended use of the nitrous oxide?

13. Please Explain Your Intended Use in Detail:

14. Expected order quantity and frequency

15. Will You Resell or Distribute These Products?

16. If Yes, Who Are Your Intended Customers and How Will You Verify Legitimate Use?

Section 4 — Delivery & Business Verification

17. Full Delivery Address

18. Is the Delivery Address Your Registered or Trading Business Address?

YES

18. If No, Explain the Delivery Location

19. If Yes, State the Destination Country, Recipient and Export Arrangements

20. Do you/your business sell any of the following products?

Section 5 — Legal Compliance Declarations

1. I confirm that my business is genuine, that all information and documents provided are accurate, and that I am authorised to make this purchase.

YES

2. I confirm that all nitrous oxide purchased will be used or supplied exclusively for lawful purposes and not for wrongful inhalation.

YES

3. I confirm that I understand and will comply with applicable UK nitrous oxide legislation, including the Misuse of Drugs Act 1971 and Regulation 4C of the Misuse of Drugs Regulations 2001.

YES

4. If reselling or distributing, I confirm that I will carry out reasonable checks on my customers and will not knowingly or recklessly supply nitrous oxide where it is likely to be wrongfully inhaled.

YES

5. Are you aware that inhalation of nitrous oxide carries the risk of serious health problems including death?

YES

6. I agree to provide further evidence of legitimate business activity, intended use and customer demand when reasonably requested, and understand that orders may be refused or cancelled if compliance requirements are not satisfied.

YES

Section 6 — Final Declaration

I declare that the information and documents provided in this application are true, accurate and complete. I understand that A2Z Creams & Coffee Appliances Limited may conduct additional verification checks and reserves the right to refuse, suspend or cancel orders where compliance concerns arise.

I confirm that I have read, understood and agree to the Terms & Conditions of A2Z Creams & Coffee Appliances Limited.

I agree to all the above declaration and terms & conditions placed by A2Z Creams And Coffee Appliances Limited

Your Signature

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Distributor & Wholesale Complience Form

Section 1 — Business Information

Company Or Trading Name (Provide Both If Different):

1. Business Structure:

Limited Company

Sole Trader

Partnership

Other

2. Company Registration Number

3. Company VAT Number:

4. Business Trading Address:

5. Business Website or Trading Platform:

Section 2 — Authorised Purchaser & Identity

6. Full Name of Authorised Purchaser:

7. Position Within the Business:

8. Business Email Address:

9. Contact Telephone Number:

Age & Authority Declaration: I confirm that I am aged 18 or over and am authorised to purchase on behalf of the business.

10. Please provide a copy of your driving license or passport for identity verification purposes using the link below.

Upload your file

Choose a file or drag and drop one here.

11. Provide appropriate evidence of trading, such as a company registration document, business invoice, trading website or business registration evidence for sole traders.

Upload your file

Choose a file or drag and drop one here.

Section 3 — Intended Use & Wholesale Distribution

12. What is the intended use of the nitrous oxide?

13. Please Explain Your Intended Use in Detail:

14. Expected order quantity and frequency

15. Will You Resell or Distribute These Products?

16. If Yes, Who Are Your Intended Customers and How Will You Verify Legitimate Use?

Section 4 — Delivery & Business Verification

17. Full Delivery Address

18. Is the Delivery Address Your Registered or Trading Business Address?

YES

18. If No, Explain the Delivery Location

19. If Yes, State the Destination Country, Recipient and Export Arrangements

20. Do you/your business sell any of the following products?

Section 5 — Legal Compliance Declarations

1. I confirm that my business is genuine, that all information and documents provided are accurate, and that I am authorised to make this purchase.

YES

2. I confirm that all nitrous oxide purchased will be used or supplied exclusively for lawful purposes and not for wrongful inhalation.

YES

3. I confirm that I understand and will comply with applicable UK nitrous oxide legislation, including the Misuse of Drugs Act 1971 and Regulation 4C of the Misuse of Drugs Regulations 2001.

YES

5. Are you aware that inhalation of nitrous oxide carries the risk of serious health problems including death?

YES

Section 6 — Final Declaration

I confirm that I have read, understood and agree to the Terms & Conditions of A2Z Creams & Coffee Appliances Limited.

I agree to all the above declaration and terms & conditions placed by A2Z Creams And Coffee Appliances Limited

Your Signature

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