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Wholesale Account Application
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Please fill in the below information to apply for a Wholesale Account. There is no obligation on your part, and upon reviewing your application we will email you regarding all wholesale stipulations, such as minimum order amounts.
Login Info
Email Address:*
Password:*
4 - 8 characters long; numbers and letters only.
Re-type Password:*
Billing Info
Company Name:*
Owner First Name:*
Onwer Last Name:*
Buyer Same As Owner:
Buyer First Name:*
Buyer Last Name:*
Address:*
Address 2:
City:*
State:
~ Select State ~
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
or
Province:
Zipcode:*
Country:
Phone:*
Website:
Tax ID:*
Store Type:*
~ Specify Store Type ~
Apparel
Baby
Bridal
Department Store
Gallery
Gift
Home Furnishings
Interior Design
Judaica
Kitchen
Museum Shop
Other
(if Other, describe below)
Number Of Locations:*
First Year Of Operation:*
How did you hear about us?:*
Notes:
* means required field
© 2008 Jill Fagin Enterprises, Inc | 212-674-9405 |
info@jillery.com
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