New Account Application

 
homeinventoryspecialsjewelrybuyingaccount applicationshippingcontact us

 
Please provide the following contact information:

 * = required field
 
FIRST NAME: *
LAST NAME: *
COMPANY / STORE NAME: *
COMPANY STORE ADDRESS: *
CITY: *
STATE: *
ZIP: *
PHONE NUMBER: * Ext.
FAX NUMBER:   
E-MAIL ADDRESS: *
POLYGON MEMBER ? * YES: NO:
ARE YOU LISTED IN JBT ? * YES: NO:
YEARS IN BUSINESS: *
YEARS AT CURRENT ADDRESS: *
CONTACT PERSON:   
   
Please list 5 trade references
Be sure to include other diamond wholesale suppliers
 
Reference 1  
COMPANY NAME:
CONTACT NAME:
CITY
STATE:
PHONE NUMBER: Ext.
E-MAIL ADDRESS:
   
Reference 2  
COMPANY NAME:
CONTACT NAME:
CITY
STATE:
PHONE NUMBER: Ext.
E-MAIL ADDRESS:
   
Reference 3  
COMPANY NAME:
CONTACT NAME:
CITY
STATE:
PHONE NUMBER: Ext.
E-MAIL ADDRESS:
   
Reference 4  
COMPANY NAME:
CONTACT NAME:
CITY
STATE:
PHONE NUMBER: Ext.
E-MAIL ADDRESS:
   
Reference 5  
COMPANY NAME:
CONTACT NAME:
CITY
STATE:
PHONE NUMBER: Ext.
E-MAIL ADDRESS:
 

You will be contacted as soon as possible regarding your account status.
 

   shaigutinc@gmail.com
   (972) 980-0608 phone
   (800) 822-0608 toll-free
   (972) 980-2969 fax

    
All content 2003 - 2010 Shai Gut Inc.  Website by D.W.D.C.