Jewel Fleet

ACCOUNT HOLDER DETAILS

Name *

Email ID *

Federal Tax ID *

Resale Tax Number *

JBT Number

Password *

Confirm Password *

COMPANY DETAILS

Registered Legal Name *

Owner/Director Name *

Type of Entity *

Select the Entity Type

State of Registration/Incorporation *

Phone Number *

Type of Business *

Retailer

Wholesaler

Manufacture

DBA/Trade Name

Name of Bank

Alternate Phone Number

Alternative Emails Ids will only be sent order confirmations & delivery updates & marketing information. Only the primary email ID can be used to sign in to your account

Alternate Email ID 1

Alternate Email ID 2

Have You Instituted An Anti-Money Laundering Program?

YESNO

- I confirm that the above information is true and correct.

- I confirm that I have provided/will provide all the required documentation.

- I will provide any changes made to the above stated information.

- I confirm that I have disclosed all relevant information.

BILLING DETAILS

Shop Name *

Street / Post box no. *

City *

State *

Zip Code *

SHIPPING ADDRESS

Multipe shipping address can be added after account is created from profile section.

Same as billing address

Shop Name *

Street / Post box no. *

City *

State *

Zip Code *