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Wholesale Application

*indicates required field
*Company Name:
*Contact First Name:
*Contact Last Name:
*Title:
*Address:
*City & State, Zip Code.:
*Country:
*Email Address:
*Phone No.:
FAX No.:
*Federal Tax ID:
*State Re-sale No.:
*3 Trade references: 1.
2.
3.

Your primary business is:	Wholesale Importer Dept. Store		Retail Store Home Base

Type of Store:		New Age/Metaphysical		Museum Gift Shop
		Jewelry Store		National Park Gift Shop
		Variety/Gift		Boutique
		Smoke Shop		Cultural/Ethnic
		Novelty		Flea Market
		Clothing Store
	other (describe)

What type of products do you sell other than jewelry?
Additional Comments:

Where did you learn about us?
How do you like our page?
Do you have a Website, if so what is the address?

Once your application is approved we will email you a user ID and password.

Please make sure you filled in your Name, Email, and Phone Number before you Submit. Thanks.


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