~ Hello Store Owners & Buyers ... Please fill out this form to get the password to shop the online Wholesale Collections & to see the termsat this site. Thank you! ~

Store Owner's Name *

Store Owner's Name

First Name

Last Name

Buyer's Name (if other than store owner)

First Name

Last Name

Store Name(s) *

Email Address *

Store Phone *

Store Phone

(###)

###

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Mobile Phone *

Mobile Phone

(###)

###

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Resale Number *

State for Resale Number above *

Date Store Opened *

Store Website, Facebook page or Blog *

Store Address *

Store Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Shipping Address (if different than store address)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Billing Address (if different than shipping)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How did you find out about my work? *

Gallery or Store Style

Other Jewelry Lines Carried at Your Store

Tradeshows You Attend and Seasons