Wampum World Jewelry Co. - www.wampumworld.com 
Wholesale Application - 50% Discount
Telephone 1-508-802-5012
Print this form Fax completed to: 1-508-824-3052 or Email to orders@wampumworld.com
You can also mail this to: Wampum World, P.O. Box 652, Raynham Center, MA 02768 USA
 (for use by individuals and organizations both profit and non-profit)

Contact Person _________________________________________________________________
 
Citizen of _____________________________________________________________________
 
Business Name _________________________________________________________________
 
Address ______________________________________________________________________
 
City ________________________________________ County ___________________________

State __________________________ Zip _____________ Country ________________________
 
Phone ____________________________ E-mail ______________________________________
 
Website _______________________________________________________________________
 
Type of Organization _____________________________________________________________
 
Affiliate or Parent Organization ______________________________________________________
 
Number of Members _____________________________________________________________
 
Main Interest ___________________________________________________________________

______________________________________________________________________________
 
State Tax Number (attach photocopy)_________________________________________________
 
Signature ___________________________________ Date _______________________________
 
Title __________________________________________________________________________
 
Print this form Fax completed to: 1-508-824-3052 or Email to orders@wampumworld.com 
Or mail to: Wampum World Jewelry Company, P.O. Box 652, Raynham Center MA 02768 USA
 
For office use only
Approval sent w/ email __________
Tax exempt cert. on file _________
Computer updated _____________