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Full Name:

Telephone:

E-mail:

Postal Code/Zip Code

Please select your level of participation:

Wholesale Customer

Independent Business Owner

Please note: 
If you choose to become a Wholesale Customer, I will send you the referral number and password, so that you can browse and shop at Quixstar.com. However, If you choose to become an independent Business Owner, you will  receive a phone call within the next few days.

Thank You for your consideration.

Carson Chan

mailto:

Tel: (604) 841-2708