Wholesale Registration Form

Please fill in this form to apply for access to our wholesale gem catalog.

The more information you provide, the easier it will be to approve your request.

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

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

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

Name
First Name:
Last Name:

Business Name:
Profession:
Company Website:
Address
Street:
City:
US State:
Choose N/A for non-U.S.
Non-US State/Province:
Postal Code:
Country:
Contact/Login
Telephone:
Email:
Your email address will be your login ID; use a permanent email because we will send your password to this address if you lose it.
Email (please re-enter):
Password:
Password must be alphanumeric and at least 4 characters long. Special symbols are not allowed.
Password (please re-enter):
Business Information
State Resale License Number:
Enter NA if your state does not issue resale licenses or if you area a non-U.S. company
Federal Tax ID:
Federal Tax ID Type:
Comments/Explanations:
JBT Number:
Mountings/Findings Suppliers

Please list other suppliers from which you purchase supplies.

Supplier 1:
Supplier 2:
References

References are not required but are helpful in establishing your status and credit.

Business Name:
Contact Name:
Telephone:

Business Name:
Contact Name:
Telephone:

Business Name:
Contact Name:
Telephone:
How did you hear about our website?
Comments?
Subscribe to e-mail updates?
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34.35 ct Lime Citrine Reflections(TM)


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Gold, diamonds and Concave Cut Lime Citrine pendant

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