We thank you for your interest in Black Hills Gold Jewelry by Coleman. Please take a few minutes to complete the following questions so that we will have the necessary information to properly evaluate your request to become a Black Hills Gold Jewelry by Coleman Retailer. Once your pre-registration has been approved, a temporary account number will be issued so that you can login to the Retailer Section on our web site. Please note that completion of our Account Application in the Retailer Section is required in order for us to process your orders.

Please note that once approved, we require a $250 order to open an account with Black Hills Gold Jewelry by Coleman. We also require a $100 re-order or a $25 service fee for each re-order that is under $100. Once your account exceeds $1500 in purchases in one year, the $100 re-order requirement is waived.


Contact Information (Required)


Name
 

Company Name

 
Mailing Address 


Company Phone Number 

Company Fax Number
 

 
Company Email Address 


Company Web Site

 
Company State Sales Tax ID.  (Oregon and Montana please use Federal Tax ID)

How did you learn about Black Hills Gold Jewelry by Coleman?

Company Background (Required)

What type of store(s) do you operate? 

Do you currently carry or have your carried Coleman Black Hills Gold Jewelry? 

Do you plan to stock Coleman Black Hills Gold Jewelry? 

How much Black Hills Gold Jewelry do you plan to stock? 

Please indicate your preferred shipping method.  

Please select your preferred method of ordering.  

Please select your shipping insurance preference.  

Please indicate your estimated markup. 

Information Disclosure

 Black Hills Gold Jewelry by Coleman reserves the right to analyze this form to evaluate and screen interested retailers. From this evaluation and screening, Black Hills Gold Jewelry by Coleman will determine if a working business relationship is possible. Please note that the information listed is considered confidential and will not be forwarded to any solicitors or any third-member parties.