Italiano Jewelry Dealer Request Form

Please provide the following information:

Name
Title
Business Name
Billing  Address
2nd Address Line
City
State
Zip/Postal Code
Business Telephone
Home Telephone
FAX
E-mail
URL

	SHIPPING INFORMATION
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country

Resale Tax ID Number.

(this number must be verifiable with your state/county/or city)

We also need to have a hard copy of your resale tax ID certificate for our files. This can either be faxed (251) 947-4536,  mailed (P.O. Box 2439, Robertsdale, Al. 36567) or emailed to our office. After registering, you will receive an email from us designating your individual discount code once the account information has been established.  We accept American Express, Discover, Master Card, and Visa.  Term accounts are not available.