Flame & Foil - Wholesale Application Form

We appreciate your inquiry into our wholesale products and your interest in Artistry in Glass. We offer no wholesale requirements on purchases other than a minimum $50 dollar order.

To receive our wholesale price list, please fill out the form below completely and click "Submit." Upon receipt of your completed form, we will review your information and reply usually within 48 hours. Thank you for your interest in Artistry in Glass and if you have any questions, please do not hesitate to contact us.

First Name :	*
Last Name :
Title :
Company Name :
Phone Number :
Fax Number :
Email address :	*
Website URL :
Years in Operation :
PST Registration number :
Resale Number :

Billing Information
Address :
City :
Province/State :
Country :
Postal Code/Zip :

Shipping Information - (If different from Billing)
Address :
City :
Province/State :
Country :
Postal Code/Zip :
Is fire hot or cold?	*
		- This confirms that you are a human user.

Note: The input below should not be filled in. It is a spam trap. Please ignore it. If you populate this input, the form will return an error.

Billing Information

Shipping Information - (If different from Billing)