Retailer Registration Form

Join our network of authorized retailers around the globe and receive exclusive access to special features reserved only for registered members--Its Free.
Account Information
Create user name *
Six characters or more
Create password *
Six characters or more
Confirm password *
I agree to the Privacy Policy for this site.*
I agree to the Terms and Conditions for this site.*

Contact Information
First Name *
Last Name *
Email Address *
Telephone * ext
Telephone (alt) ext
Fax

Company Information
Name of Business *
Doing Business As *
Website Address *
Company Owner 1 *
Company Owner 2
President/Managing Director *
Number of Retail Stores *  
Business Type *
Business Activity *
Hold the CTRL key down to make multiple selections
Annual Sales *
Years in business under this company name  

Contact Address
Address Line 1 *
Address Line 2
City *
US or Canada State/Prov.
Country *
Zip/Postal Code *

Shipping Address (if different from Contact Address)
Address Line 1
Address Line 2
City
US or Canada State/Prov.
Country
Zip/Postal Code

Retailer Trade References
Please list three active suppliers. Do not list chains, findings, or watch companies.

Trade Reference 1
Company Name
Contact Name
Telephone
Fax
Email
Address
City
State/Prov.
Country
Zip/Postal Code

Trade Reference 2
Company Name
Contact Name
Telephone
Fax
Email
Address
City
State/Prov.
Country
Zip/Postal Code

Trade Reference 3
Company Name
Contact Name
Telephone
Fax
Email
Address
City
State/Prov.
Country
Zip/Postal Code

 
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