New Customer Application Form

Store Name:*
E-mail:*
Owner's Name*
Phone:*
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Fax:
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Store Address:

Company Information

How long have you been in Business:
Retail Sales Tax ID # (international customers leave blank):
Business Classification:
If Corporation, Date of Incorporation:
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Word Verification:

After you hit Submit, a Jinny sales representative will go over your information and call you.