HANDCRAFTED   JEWELRY
by Austin Design and Sand . Sea . Sun

Password & Wholesale Catalog Request for Wholesale Buyers

Please fill this out, print the form, then FAX to 434-832-7090.

or MAIL the information to: Austin Design Jewelry Inc., 110-B-Duncraig Dr., Lynchburg, VA, 24504

You may also E-mail this informaion to verify08 @ AustinDesignJewelry.com
Please be sure to include all the required * fields in your email.
 

* Business / Store Name:

 

* Business Phone:

 

*Contact / Buyer's Name:

 

  Business Fax:

 

* Tax ID or Retail License #:

 

   E-mail:

* Mailing Address:

 

 

 * Shipping Address:

* City:

 

   City:

* State:

 

   State:

* Zip:

 

   Zip:

* Type of store:

 

 

 

 

 

 * Types of jewelry, merchandise, etc. sold:

 

Thank you for your interest!
Once we receive and verify your wholesale status,
we will send you a full color catalog, current price list, order form, and password.