Funky3Dfaces reseller application form

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[av_contact email=’info@funky3dfaces.com’ title=’Register your interest at becoming a Funky3Dfaces reseller below and one of our team will contact you.’ button=’Submit’ on_send=” sent=’Your message has been sent!’ link=’manually,http://’ subject=” autorespond=” captcha=” form_align=” color=’av-custom-form-color av-dark-form’ admin_preview_bg=”]
[av_contact_field label=’Name’ type=’text’ check=’is_empty’ options=” multi_select=” av_contact_preselect=” width=”][/av_contact_field]
[av_contact_field label=’E-Mail’ type=’text’ check=’is_email’ options=” multi_select=” av_contact_preselect=” width=”][/av_contact_field]
[av_contact_field label=’Contact Number’ type=’text’ options=” check=’is_phone’ width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Country of residence’ type=’text’ options=” check=’is_empty’ width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’City or State’ type=’text’ options=” check=’is_empty’ width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’In store – Tick this box if you wish to take orders directly with the customer present’ type=’checkbox’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Online – Tick this box if you would like to sell online’ type=’checkbox’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Message’ type=’textarea’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[/av_contact]

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