BCAM - Retailer Registration Form

Breast Cancer Action Month runs every year from 1 to 31 October. Support the New Zealand Breast Cancer Foundation by hosting a Pink Ribbon Merchandise donation box. These boxes come pre-packed so all you need to do is pop it on your counter and let your generous customers donate! Then in the first week of November, we ask that you bank the contribution and return any remaining merchandise. Easy! Why not make this a Nationwide initiative and have all your outlets join in!

To register your interest please complete the following:

Contact Person Details

Title
First Name *
Last Name *
Company *
Address * (No PO Boxes please)
Suburb
City *
Postcode *	Click here to find NZ Postal Code
Phone *	(Please include your area code without any spaces. Eg: 093456789 or 021456789)
Mobile *	(Please include your area code without any spaces. Eg: 093456789 or 021456789)
Email *
Area *
Number of outlets *

Please supply us with the following:

Merchandise Boxes (each box contains a selection of our Official Pink Ribbon merchandise.)	(Number of boxes )
Pink Ribbon Boxes (each box contains 50 x ribbons)	(Number of boxes )

Comments/Queries

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