wholesale @ Bico Pacific

Wholesale

“Welcome and thank you for your interest in Bico Australia Jewelry.
For further wholesale information including pricing, Please complete the form below only If you are interested in becoming a Bico retailer.
This information will not be shared or sold to any third party.
Feel free to contact us directly with any questions.“

(Fields marked with asterisk * are mandatory)

First Name : *

Last Name: *

Street Address: *

Unit:

City: *

State: *

Zip: *

Country:

Phone: *

Area code Number (xxx) (xxx-xxxx)

Alternate phone:

Area code Number

Fax:

Area code Number

Email Address: *

Confirm Email Address: *

Interested in:

Cart in a Mall (an extended application form will be forwarded)

Kiosk in a Mall (an extended application form will be forwarded)

In Line Store (an extended application form will be forwarded)

Online Store:

Add on to an existing website?

Please indicate your website address:

Fairs / Festivals / Special Events
(A list of locations and dates will need to be provided)

Mailing Catalog; Name of catalog:

House Parties

Add on to an existing store; please provide store information:

Business Name:	Resale #
Owners Name:
Number of Stores:	Years in Business: Type of Business:
Street Address:	Unit:
City:	State: Zip:

How did you
hear about us?

Comments:

Security Code:

Please enter security code