Wholesale Form


Returning Customer

A person or company willing to become a wholesale customer of our products needs to purchase the reseller kit.

After filling out the following form and receiving your reseller kit you will be registered

as a reseller and entitled to wholesale pricing.

The reseller kit is a turnkey package that costs $200 and includes the following :

1) Molding (impression) material- 1 Box (up to 36 molds)

2) Molding trays- 3 bags (12 trays in each bag)

3) T V Jewelry Catalog

4) Wholesale price lists

5) Order forms

6) Tax Forms

7)T V Jewelry Posters

8) Wholesale Instructions

9) TV Johnny/TV Jewelry Promotional DVD

Select a user id:	5-12 characters
Select a password:	5-12 characters
Verify password:	5-12 characters

Company Name:
First Name:
Last Name:
(Optional) Nickname:
Billing Address :
City:
State:
Zip/Postal Code:
Shipping Address if different than above :
City:
State:
Postal Code:
Phone Number:
Fax Number:
Email Address:
Credit Card Type:
Credit Card Number:
Credit Card Expiration :	example: 02/08
CVV (Security) Code:	3 digits from back of card or 4 digits from front if AmEx

Please Note: An automatic confirmation will NOT be issued after submitting this order form. Instead, a processor from our

wholesale department will contact you within 24 to 48 Hours. Please call 713 777 2026 x103 if you would like further assistance or need to talk to us about your order.

Those who would like to pay by Check or Money order can mail their application to :

ATTN: TONY-- TV Jewelry

7255 Clarewood Dr

Suite 300

Houston, TX 77036

** It is the reseller's responsibility to file their taxes and report taxes collected from their customers.

T V Jewelry must have a copy of each reseller's Tax ID number or business license on file.**