Wholesale account Application

Jala Wholesale Application
Legal Business Name*
DBA *
Phone:*

Area CodePhone Number
E-mail:*
Website (copy & paste your website url)*
Facebook
Twitter
Other Social Media Sites
Shipping Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
In Business since*

MonthDayYear
Is the Business in California?*

YesNo
Federal Tax ID*
California Reseller Tax ID*
Type of Business*

InternetBricks and mortar
Business Description*

BoutiqueSpeciality StoreDepartment StoreYoga StudioPilates StudioGymOther
Store Information
Store Address :*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail:*
Website (copy & paste your website url)*
Business Representative Information
Full Name*

First NameLast Name
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Additional Information
How did you learn about Jala Clothing?*
Message

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Please provide us with a photo of your store if it is not on your website.

Upload a File

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If you are in the state of CA, please provide us with a copy of your Reseller ID Certificate.

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Jala Wholesale Application