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New member

New Wholesale Members

The form below is for wholesale customers who own and operate retail outlets. It allows you to create a profile which is necessary to place wholesale orders. Do not forget that this information is essential to use our services correctly.

If you are a retail customer and would like to purchase RED EYE GLASS products, there is no need to fill out this form. Please go to our links page to find retail outlets that carry our products.

If you already have an account, please login from here. If you are a new customer we need to know your company information. Please fill in the form below and click 'Submit'.

Fields marked with * are mandatory.


E-mail & Password
E-mail *
Password *  
Confirm password *  
Password hint  
Password hint answer  
 
License
GST license if applicable:    
Business license number:    
Billing Address
Title  
Company *
First Name *
Last Name *
Phone *
Fax  
Address *
Second address line
City *
Province/State *
Postal Code/Zip code *
 
Shipping Address (leave empty if same as billing address)
Title  
Company *
First Name *
Last Name *
Phone *
Fax  
Address *
Second address line
City *
Province/State *  
Postal Code/Zip code *
 
Register to become a Red Eye Glass Preferred Vendor
Membership  

  By clicking "SUBMIT" you are agree with our Terms & Conditions.

Submit