Wholesale account Application

Jala Wholesale Application
Legal Business Name
DBA
Phone:

Area CodePhone Number
E-mail:
Website (copy & paste your website url)
Facebook
Twitter
Other Social Media Sites
Shipping Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
In Business since

MonthDayYear
Is the Business in California?
Federal Tax ID
California Reseller Tax ID
Type of Business
Business Description
Store Information
Store Address :

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail:
Website (copy & paste your website url)
Business Representative Information
Full Name

First NameLast Name
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Additional Information
How did you learn about Jala Clothing?
Message

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Please provide us with a photo of your store if it is not on your website.

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If you are in the state of CA, please provide us with a copy of your Reseller ID Certificate.

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Jala Wholesale Application