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PRINT
Wholesaler Application Form
Please print and sign the following
documents and fax it to us at 626-810-3231
along with your business license and driver license.
Cerijewelry
1116 Coiner Court., City of Industry, CA 91748
Office: 626-810-3283
Fax: 626-810-3231
Email: sales@cerijewelry.com
By signing this
agreement and the wholesale buyer's company certifies that the company is in
the business of reselling merchandise and have provided proper business and
resell license information to Cerijewelry.
The wholesale buyer's company acknowledges and agrees to the terms and
policy set forth in Cerijewelry
wholesale agreement. The wholesale policy is available for review at
Wholesale Buyer's Company
Your Order Number: _______________________________________________
Contact Name:____________________________________________________
Title:_____________________________________________________________
Company
Name:__________________________________________________
Phone
Number:____________________________________________________
Fax
Number:______________________________________________________
E-Mail:___________________________________________________________
Seller’s Permit #
(Require if you are located in
California
in order for us to waive sales tax on purchase)
_________________________________________
CREDIT CARDHOLDER AUTHORIZATION FORM
Date: _______________
I, ______________________________________________ (Name of cardholder as it
appears on the credit card)
authorize Cerijewelry, to charge Credit Card Type (Visa/Mastercard/American Express/Discover)
________________________________
Name on Credit card
____________________________________________________
Credit Card Number
_____________________________________________________
Expiration Date
_________________________________________________________
CVV Code (3 Digits on the back of Visa/Mastercard/Discover Card or the 4 Digits on the front of
the American Express Card)
__________________________________________________
for wholesale purchases placed with Cerijewelry.
Note:
1.. Please provide the 800 customer service number on the back of your card
2.. Please provide the address that matches with the
credit card monthly statement below.
3.. Sign and fax this form along with a copy of your
driver license to 626-810-3231 .
800 Customer service # _________________________
Billing Address:
___________________________________________________
City
________________
State: ________ Zip:
_____________
By signing below, I authorize Cerijewelry
to charge my credit card for payment for my wholesale purchases. This
authorization will remain in effect until the business relationship is
terminated with a formal written request.
Authorized Signature
Sign By
________________________________
Print Name:_____________________________
Date: __________________________________
PRINT Wholesaler Application Form
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