Contact Name:*

Business Name:

Business Registration Number:

Phone Number:

Fax Number:

Postal Address:

City:

State:

Postal code:

Country:

Email Address:*

Web site:

What is your Business category?

• I have a current website and am looking to add flowers and/or gifts to my product range
• I am in the process of constructing a website and am looking to add flowers and/or gifts to my product range
• I currently have a website that sells flowers and/or gifts and am looking to change suppliers
• I have a current or potential Member Group (eg. shopping discounts, member benefits) and am interested in providing them with a discount on their flower and/or gift purchases
• Other:

How do you hear about us?

• I searched for 'flower and/or gift affiliate programs'
• I searched for 'affiliate programs' in general
• I found Teleflora New Zealand by searching using other keywords.
• I have seen Teleflora New Zealand on other Affiliate sites
• I have been recommended to contact Teleflora New Zealand by other Affiliates
• I have used Teleflora New Zealand before
• Other:

Your commission or discount structure will depend on the way in which you'd like to trade with Teleflora New Zealand. How would you like to collect your Teleflora New Zealand Orders?

• I'd like to place a link to Teleflora New Zealand on my site to collect orders (Affiliate Option 1)
• I'd like to use my site's own shopping cart to collect orders (Affiliate Option 2)
• I'm unsure how to collect orders and need assistance to work out my best option

Orders collected through a shopping cart will need to be sent to Teleflora New Zealand. How would you like to send these orders ?

• Online via the Teleflora New Zealand Ordering Website
• Teleflora New Zealand API Interface (XML)
• Unsure

This can be based on your other product sales if you have a current website.

• 1 - 10 orders per month
• 10 - 20 orders per month
• 20 or more per month
• Unsure

What is your site's current traffic stats per month:

How helpful was this site:

• 1 - Poor
• 2
• 3
• 4
• 5 - Excellent

Extra Information/Comments

What is the sum of 1 + 1?*

Thank you for completing the Registration of Interest form. We will process your form and will be in contact with you.