OFFICE USE ONLY

CUSTOMER ID:
2600 S. Soto St. Los Angeles, CA 90058
TEL: (877)500-9994 ● FAX: (877)500-9952 PROCESSED BY:
REGISTRATION FORM

BUSINESS NAME: STORE PHONE#:

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ADDRESS: MOBILE PHONE#:
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CITY: STATE: ZIP CODE: STORE FAX#:
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SELLER’S PERMIT NO: YEAR EST.:

BUSINESS TYPE:
□ 1. Dollar Only Store □ 8. Gift Shop □ 15. Pharmacy/Drug Store
□ 2. Discount Store □ 9. Flower Shop □ 16. Gas Station
□ 3. Wholesale □ 10. Hardware Store □ 17. Clothing Store
□ 4. Import/Export □ 11. Toy Store □ 18. Swap Meet
□ 5. Grocery Store □ 12. Party Store □ 19. Coin Laundry
□ 6. Liquor Store □ 13. Pet Store □ Other:
□ 7. Restaurant □ 14. Beauty Supply Store

OWNER’S NAME:

DRIVER’S LICENSE NO. / PASSPORT NO.: E-MAIL ADDRESS: **FOR RECEIVING MONTHLY PROMOTIONS

HOW DID YOU FIND ABOUT OUR COMPANY? (PLEASE CHECK ONE)
□ 1. Friends / Relatives □ 4. Event / Exhibition
□ 2. Internet Search Engine □ 5. Previous / Other Owners
□ 3. Walk-in □ 6. Other:

Terms & Conditions:

Minimum purchase amount: $1,000. A deposit is required upon acceptance of an order. Claims for shortage or damaged goods must be
reported within 2 business days of receiving of orders. A 20% restocking fee will be charged on all returns, cancellations or replacements.
A $25 fee will be charged for all returned checks for any reason whatsoever. Returned goods must be in its original package and condition
accompanied by original receipt within 5 business days from receiving of orders. All seasonal product sales are final. A charge of 1.5% per
month will be assessed for any balance due. If any legal actions are brought to collect the invoice or for any dispute or controversy arising
out of the transaction, the prevailing party shall be entitled to recover attorney’s fees and other cost incurred, whether or not suit is filed.
Parties hereby consent to the laws, venue and jurisdiction of Los Angeles, California.
The above information is true to the best of my knowledge. I accept JC Sales terms and conditions and I understand that I am financially
responsible for any balance.

Signature: Date: / /