SUPPLIER MEMBER APPLICATION

As of April 1, 2012

Required fields - *

Business contact information

Name of Business Applying for Membership*
DBA (if applicable)
Headquarters Street Address*
City* State*
Zip Code*Country (if outside U.S.)
Business Phone* Business Fax*
Business Email* Website
General Membership Contact*Title*


Public Relations Contact:

NameTitleEmail

Accounts Payable Contact:

NameTitleEmail

Business Information

Annual Sales Volume* Total# of Employees*

Year Established*


Do you collect sales/use tax?*
(If yes, enter your Tax ID at right)

Tax ID Number (if you collect sales/use tax)

List below the names & addresses of three (3) industry references: (supplier, bank, etc.)*
Name and Address*
Name and Address*
Name and Address*


How did you hear about JA?









Type of Business:  (categories for Supplier Directory - select all that apply)

PRODUCTS



















SERVICES
 







Other

payment information

PRORATED dues schedule
(As of April 1, 2012)

Dues Amount + Application Fee (review chart at right to determine your required dues amount)*

Charge the above amount to my:*


Card Number*
Expiration Date*
Name on Card*
Signature*
Annual Sales Volume
Dues Amount
Less than $2,000,000
$295
$2,000,001 - 10,000,000
$435
$10,000,001 - 25,000,000
$655
$25,000,001 - 50,000,000
$990
$50,000,001 - 75,000,000
$1,575
Over $75,000,001
$2,510


New member applications only
Click for full-year dues schedule

application fee

$35


code of professional practices

A condition of membership in Jewelers of America is an annual commitment to our Code of Professional Practices. Read the Code and then pledge your commitment to it by checking and signing below.

Click here to read the Code of Professional Practices, then check and sign below.


I have read and, as an individual and as a company, will abide by the Code of Professional Practices. I affirm that I have the authority to make such a commitment on behalf of my company.
Signature*

what you must include with application:

To complete your application, Jewelers of America requires examples of the following supplemental materials. You can upload images, files and scanned copies of documents here. If you do not have electronic files available, please send copies of the following to: By Mail -- Jewelers of America, Member Services, 52 Vanderbilt Avenue, 19 Floor, New York, NY 10017, re: Order Form Reference Material; By Fax -- (646) 658-0256. Your application will not be processed until all supplemental materials are received.

Payment (see Dues Schedule above)

Copy of Business Card or Stationery (doc, pdf)

Copy of Business License (doc, pdf)




Title