Wholesale Enquiry

Customer Information

Title (Select) *

First Name *

Last Name *

Company Name

Contact Information

Phone Number *

E-Mail *

Mobile Number

Do you prefer to be contacted via phone or email?

Store Information

Number of stores *

Number of Years in Business *

Complete physical address of each location if you intend to carry our line there *

Website Address

I do not have a website but will email pictures of my store (inside and out) to song@bijouxbox.com.au .I understand that my application will not be processed until after the photos have been received.

Days and hours of operations

What % 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/crafts	Fine Jewelry

Please list four brands or jewelry designers you currently carry in-stock:

Brand 1 *

Brand 2 *

Brand 3

Brand 4

Notes

Provide your ABN and ACN references :

ABN Number :

ACN Number