Beads Membership Request Form

Terms marked in red are mandatory.

First name
Last name Middle initial Title
Organization (If iyou are a business
Street address Additional Info. 
City
State/Province  
Zip/Postal code
Country Additional Information   
Work Phone
OR  Home Phone
FAX
E-mail

URL/Your Web Site

Please describe your business or activity:

What kind of products you buy on line; Please describe:

Wholesale Prices:
We have 3 levels of prices
In order to receive or to view wholesale prices you must meet the following :
Please check your monthly orders volume:

$250.00/Month             $500.00/Month              $750.00/Month           $1000.00/Month- and Up.

Please write 3 trade references that you are buy from, Please write full name and Telephone number

Upon evaluation of your information, we will let you know the price level assigned to you.

We are planning to add additional line items:
In order to serve you better, please select type of products you would like to buy on line:

Additional interest, please write 

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