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Section A

Name:
Company Name: (Required)
Address: (Required)
City, State, Zip Code: (Required)
Telephone (include area code): (Required)
FAX (include area code):
Toll Free (optional):

Section B

Do you have a JBT Listing? YES NO
(If NO, please fill in credit references)
If YES, what is your JBT Rating:

Credit References:
Company Name Contact Person Phone Number FAX Number

Section C

I currently have a website.
My address is: www. (Required)

My current e-mail address is: (Required)

An Optional Link for the Thank-You Page:
Link Text:
Link URL:

Section D

Choose a markup option for DIAMONDS (read registration instructions for explanation):
(At least one of these markup options must be selected)

Option A
Markup my wholesale prices by %

Option B
Markup my wholesale prices by $ (dollars)

Option C

Wholesale cost between ($100 - $1,000) add %
Wholesale cost between ($1,001 - $3,000) add %
Wholesale cost between ($3,001 - $5,000) add %
Wholesale cost between ($5,001 - $10,000) add %
Wholesale cost between (over $10,000) add %

Section E

Choose a markup option for EARRINGS (read registration instructions for explanation):
(At least one of these markup options must be selected)

Option A
Markup my wholesale prices by %

Option B
Markup my wholesale prices by $ (dollars)

Option C

Wholesale cost between ($100 - $1,000) add %
Wholesale cost between ($1,001 - $2,500) add %
Wholesale cost between ($2,501 - $5,000) add %
Wholesale cost between ($5,001 - $10,000) add %
Wholesale cost between (over $10,000) add %