Wholesale Account Application
Name
*
First Name
Last Name
Age
*
Brand Name
*
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
City, State
*
How Did You Hear About Us?
Google / Search Engine
Word of Mouth
Website
Received an Email
Other
Instagram Profile
*
If you dont have type n/a
Facebook Page
*
If you dont have type n/a
Marketing Experience
*
None
Some Experience
Very Experienced
Expert
Any Experience with Jewelry
*
Yes
No
If yes, explain
Describe Yourself (EX: Strenghs & Skills)
*
100 Characters Minimum
Goals with Selling Jewelry
*
100 Character Minimum
Any Documents or Files
Browse Files
Cancel
of
Submit
Should be Empty: