Wholesale Registration Form

WHOLESALE REGISTRATION FORM

Please fill in this form to apply for access to our wholesale gem pricing. The more information you provide, the easier it will be to approve your request.

In addition to giving you access to wholesale pricing on our website, we will send you our show invitations in the mail and will add you to our news email list!

Press the REGISTER button at the bottom of the page when you are finished filling out the form.

*Items with a red star are required fields that must be filled out to confirm your wholesale status.

1Personal Information

2Business Information

3Mountings/Findings Suppliers

4References

5Other Information

Personal Information
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
This email address will be used to access wholesaler benefits. Please use a permanent email address. If this email address changes, you will need to contact us at info@brendasmithjewelry.com.
Enter Email Confirm Email

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Business Information
Business Name*
Profession*
Business Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Business Phone*
State Resale License Number*
Enter N/A if your state does not issue resale license or if you are a non-U.S. company.
Federal Tax ID*
Federal Tax ID Type*
Comments/Explinations
JBT Number*

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Mountings/Findings Suppliers
Please list other suppliers from which you purchase supplies.
Supplier 1 Name*
Supplier 2 Name*

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References
References are not required but are helpful in establishing your status and credit.
Reference 1
Business Name
Contact Name
Phone
Reference 2
Business Name
Contact Name
Phone Number
Reference 3
Business Name
Contact Name
Phone Number

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Other Information
How did you hear about our website?*
Would you like to subscribe to email updates?*
Would you like to receive updates via text message?*
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Phone
This field is for validation purposes and should be left unchanged.

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