Distributor Application Form
The fields marked with * are required. 

CUSTOMER INFORMATION
Title *
First Name *
Last Name *
Company  
BILLING ADDRESS
First Name *
Last Name *
Address *
Address (line 2)  
City *
State *
Country *
Zip/Postal code *

 


CONTACT INFORMATION
Phone *
E-Mail *
Do you prefer to be contacted via phone or email?  
STORE INFORMATION
Store trade name
Legal name  
Sales tax or resale number
Federal tax id number
Number of stores
Complete physical address of each location if you intend to carry our line there
Number of Years in Business
Website Address  
I do not have a website but will email pictures of my store (inside and out) to service@alexfraga.com. I understand that my application will not be processed until after the photos have been received.  
Days and hours of operations  
What percentage of your business is jewelry?
What is your best selling price point
Where did you hear about us?  

Primary type of business:
Fashion Clothing Store  
Fashion accessories/jewelry  
Gift store  
Art/gallery/craft gallery  
Fine Jewelry  

Please list four brands or jewelry designers you currently carry in-stock:
Brand 1
Brand 2
Brand 3
Brand 4

Accounting department: Please provide details below of the person responsible for A/P:
Name *
Tel *
Fax

Provide 4 trade references including contact information:
Trade reference 1 * 
Trade reference 2 * 
Trade reference 3
Trade reference 4