Selected business channel

Premium trade application.

For hospitality venues, salons, optical practices, frame destinations, retailers and aligned businesses interested in Fonteira or Dani D.

A · Business

Business details

Registered legal name *

Trading name *

Company / entity registration number

VAT number, if applicable

Business type *

Website or primary social profile

Physical business address *

B · Contact

Primary applicant

Full name *

Position / role *

Mobile number *

Email address *

Business telephone *

Business email *

C · Portfolio

Brand and placement interest

Portfolio interest *

Fonteira - premium still and sparkling waterDani D - luxury eyewear

Number of locations *

Estimated opening or monthly volume

How would the portfolio be presented or used? *

Relevant brands or categories currently stocked

D · Fulfilment

Courier delivery address

Customer collection is not currently offered. Provide a complete business delivery address.

Street address / building / suite *

City / town *

Province *

Postal code *

Authorised recipient *

Recipient mobile *

Courier access notes

E · Consent

Application declaration

I confirm that I am authorised to submit this application and that the information provided is complete and accurate. * I understand that Veridia will review portfolio fit and may approve, decline or request further information at its discretion. * I consent to Veridia processing these details for application review, account administration, fraud prevention, fulfilment and necessary business communication, as described in the privacy notice. * Optional: I give consent to receive Veridia portfolio and trade marketing updates by email. I may withdraw this consent at any time. Optional: I give consent to receive Veridia portfolio and trade marketing updates by WhatsApp. I may withdraw this consent at any time.

Submitting an application does not guarantee account approval, exclusivity, availability or supply.