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austin design
   
WHOLESALE  VERIFICATION  FORM
Password & Wholesale Catalog Request

If you are a wholesale buyer and wish to view our jewelry online or wish to receive our full color catalog, we do require that you verify your wholesale status.  This is necessary before passwords are issued, wholesale catalogs are released, or any orders are processed.  If you prefer, you may print this form and then fax or mail the information.   * Fields marked with an asterisk are required.
   

CONTACT  INFORMATION
 
Store Name: Store Phone:
   * *   
   
Contact/Buyer's Name: Store Fax: 
   *
   
Owner's Name (if different from above) E-Mail Address:
*   
   
Store  Address:   Mailing  Address:
(actual physical location of your store) Do you have a seperate mailing address?
   * *   
   
      *  City City   
* State  * Zip State Zip 
        *   Country / Area Country/Area        
 
STORE  &  BUSINESS  DETAILS
 
* Type of Store:                                 If "other" please specify:  
 
* Location of Store:                   If "other" please specify:  
 
   Are you a member of  Wholesale Crafts.com ?           If "yes", please enter your member #:  
 
* Types of Merchandise sold:  (What percentage of your total sales is jewelry?)   
 
* Hours & Days of Operation:                         * Years in Business:   
 
* Business Classification:                If "other" please specify:  
 
* Retail Re-sale License #  (a.k.a. State Tax I.D. Number):          *  (required)
 
  Tell us a little about your store, clientele, and merchandise; mention any details which will help us serve you better!
 
PRIVACY  &  TERMS  &  CONDITIONS
 
•  I realize my confidentiallity is protected, and my information will not be sold or shared.
•  I certify that all the details provided on this form to Austin Design Jewelry Inc. are true and correct.
•  I guarantee that I am indeed a true retailer, legally able to purchase wholesale, and not a personal buyer.
 
 I have read & agree to the above terms and conditions.    
 
          




Our Response
Upon verification (usually 1 or 2 business days) we will email you a password
and mail you a full color catalog and price list.

Confidentiality
We do not sell, trade, or share our mailing lists or client information. Any information submitted is kept in strict confidence.
If at any time you would like to be removed from our files, simply contact us. Filling out this information
carries no obligation whatsoever. And we do not practice any phone or e-mail solicitation!

Problem?
Having trouble submitting this form? Don't forget that fields marked with * are required.
If you would prefer to have a print version of this form, click here, and fax to 434-832-7090.
 


pdf  Adobe PDF (75.9kb)