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  Please complete the details below for us to set up an online account, and then press Send.
Please note we will require proof of qualifications before setting up an account.


  Full name: *
  Trading name: *
  Address: *
  Postcode: *
  Email Address: *
  Telephone number: *
  Specify a password for a new account: *
  Qualifications held: *
  Type of business: *
  What trade magazines do you subscribe to: * None Scratch Professional Beauty Guild News Other
  Other (* if 'Other' ticked):
  Where did you hear about us?: *
  Current account number if available:
  Would you like to be added to our email database: * Yes No
  Do you require an information pack: * Yes No
  Message: *
 
Please make sure you have completed ALL required fields before pressing
  * denotes required fields
  **Please email a picture of your certificate to info@palmsextra.com
Or fax to 01733 232 370
Or post a copy to Palms Extra Ltd,7 Holkham Road, Orton Southgate, Peterborough,PE2 6TE
Please do not send originals.