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KALLATI ◉

RETAIL CUSTOMER
APPLICATION

1. APPLICANT & BUSINESS INFORMATION

Legal Business Name DBA / Trade Name

Registered Business Address

City State ZIP

Phone General Email Website

Business Type

Federal Tax ID / EIN State of Formation In Business Since JBT #

Business Location

Owned Leased

At Current Address Since

Resale Certificate / Sales Tax ID Certificate attached

Description of Business

2. OWNERSHIP / PRINCIPAL INFORMATION

List owners, partners, members, officers or directors as applicable. Do not include Social Security numbers on this form.

Full Name	Title / Role	Phone	Email

3. BILLING & SHIPPING INFORMATION

Billing Address (if different) City / State / ZIP Shipping Address (if different) City / State / ZIP

Preferred Ship-To Contact Phone Email

4. CREDIT REQUEST & BANKING INFORMATION

Complete banking information only if requested for KALLATI credit review.

Requested Payment / Credit Terms

Bank Name Bank Contact Bank Address City / State / ZIP Bank Phone Type of Account(s)

5. TRADE REFERENCES

Please provide three major jewelry-industry suppliers or trade references.

Company Name	Contact	Phone	Email

6. KEY ACCOUNT CONTACTS

Primary Buyer Name Title Phone Email

Accounts Payable Name Title Phone Email

Marketing Name Title Phone Email

Instagram Other Social / Handle

7. CERTIFICATION & AUTHORIZATION

Applicant certifies that the information provided is accurate and complete and authorizes KALLATI, subject to applicable law and its approved credit process, to contact business, bank and trade references for account and credit evaluation. Account approval and payment terms remain subject to KALLATI approval.

Authorized Signer – Printed Name Title

Signature

Date I certify and authorize the application above.

Your application will be sent securely to the KALLATI store contact email.