Beads Membership Request Form

You must fill in the bottom your full name, address and telephone number.

Important - Our Privacy!
We don't trade, rent or sell any information about our members or customers!


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:

Beads   Paper Goods   Fashion, Apparel, Accessories
Jewelry Lingerie; Accessories Cleaning Goods
Family Planning Items Gifts Perfumes, Skin Care
Baby Needs Small Appliances Bed, Bath, Kitchen
Wedding Needs As Seen on TV School Supplies
Vitamins, Health Items Home Improvement Gourmet Food

Additional interest, please write 

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Please add any additional comments here, Thank you in advance for your help
.

        Thank you for becoming a member of  http://cyberselect.com