Sophia and Chloe Jewelry

Hello Admin,

A user has submitted new application form for wholesale store.
Below are the details submitted by user.

CUSTOMER INFORMATION

First Name: {0}
Last Name: {1}
Title: {2}
Company Name: {3}
Company Website : {4}
Email Address : {5}
   

BILLING ADDRESS

First Name {6}
Last Name {7}
Title {8}
Address {9}
City {10}
State {11}
Country {12}

Zip/Postal Code

{13}
Phone {14}
   
SHIPPING ADDRESS
First Name {15}
Last Name {16}
Title {17}
Address {18}
City {19}
State {20}
Country {21}

Zip/Postal Code

{22}
Phone {23}
   

CONTACT INFO

Phone {24}
Fax {25}
Email Address: {26}
   

ACCOUNTING INFO

Name of Person in Charge of A/P {27}
Phone {28}
Fax {29}
Email Address: {30}
   

STORE INFORMATION

Store Trade Name

{31}

Store Legal Name

{32}

Website Address

{33}

How do you want to be listed on our website

{34}

Sales Tax or Resale Number

{35}

Federal Tax ID Number

{36}

Number of Stores

{37}

Number of Years in Business

{38}

Days & Hours of Operation

{39}

What is your primary type of business

{40}

What percentage of your business is jewelry

{41}

What is your best selling price point

{42}
Please list 4 Brands or Jewelry Designers that you currently carry in-stock

Brand 1

 {43}
Brand 2 {44}
Brand 3 {45}
Brand 4 {46}
Please list 4 Trade Referneces

Trade Reference 1

 {47}
Trade Reference 2 {48}
Trade Reference 3 {49}
Trade Reference 4 {50}

Where did you hear about us

{51}
   

Password

 {52}