Distributor Registration

If you are interested in becoming a distributor for the Je T'aime Fragrances line of premium quality products, please complete the following form. You will be contacted following verification of the information provided, usually within 48 hours.

 - If you have questions or require assistance, our Live Support representatives will be happy to assist you in any way they can.

* - indicates a required field

Distributor Registration
Company Name	*
Address Line 1	*
Address Line 2
City	*
County
State	AL - ALABAMA AK - ALASKA AZ - ARIZONA AR - ARKANSAS CA - CALIFORNIA CO - COLORADO CT - CONNECTICUT DE - DELAWARE DC - DISTRICT OF COLUMBIA FL - FLORIDA GA - GEORGIA HI - HAWAII ID - IDAHO IL - ILLINOIS IN - INDIANA IA - IOWA KS - KANSAS KY - KENTUCKY LA - LOUISIANA ME - MAINE MD - MARYLAND MA - MASSACHUSETTS MI - MICHIGAN MN - MINNESOTA MS - MISSISSIPPI MO - MISSOURI MT - MONTANA NE - NEBRASKA NV - NEVADA NH - NEW HAMPSHIRE NJ - NEW JERSEY NM - NEW MEXICO NY - NEW YORK NC - NORTH CAROLINA ND - NORTH DAKOTA OH - OHIO OK - OKLAHOMA OR - OREGON PA - PENNSYLVANIA RI - RHODE ISLAND SC - SOUTH CAROLINA SD - SOUTH DAKOTA TN - TENNESSEE TX - TEXAS UT - UTAH VT - VERMONT VA - VIRGINIA WA - WASHINGTON WV - WEST VIRGINIA WI - WISCONSIN WY - WYOMING NA - NOT APPLICABLE*
Province/Region
Country	*
Postal Code	*
Contact Name	*
E-Mail Address	*
Phone Number	*
Fax Number
Website Address
Sales Tax ID Number	*
State Of Issue	AL - ALABAMA AK - ALASKA AZ - ARIZONA AR - ARKANSAS CA - CALIFORNIA CO - COLORADO CT - CONNECTICUT DE - DELAWARE DC - DISTRICT OF COLUMBIA FL - FLORIDA GA - GEORGIA HI - HAWAII ID - IDAHO IL - ILLINOIS IN - INDIANA IA - IOWA KS - KANSAS KY - KENTUCKY LA - LOUISIANA ME - MAINE MD - MARYLAND MA - MASSACHUSETTS MI - MICHIGAN MN - MINNESOTA MS - MISSISSIPPI MO - MISSOURI MT - MONTANA NE - NEBRASKA NV - NEVADA NH - NEW HAMPSHIRE NJ - NEW JERSEY NM - NEW MEXICO NY - NEW YORK NC - NORTH CAROLINA ND - NORTH DAKOTA OH - OHIO OK - OKLAHOMA OR - OREGON PA - PENNSYLVANIA RI - RHODE ISLAND SC - SOUTH CAROLINA SD - SOUTH DAKOTA TN - TENNESSEE TX - TEXAS UT - UTAH VT - VERMONT VA - VIRGINIA WA - WASHINGTON WV - WEST VIRGINIA WI - WISCONSIN WY - WYOMING NA - NOT APPLICABLE*
Territory Desired
Company Type	Corporation Partnership Sole Proprietorship Other*
Sales Manager
# of Sale Reps
Do you participate in Trade Shows	YES NO*
Which ones/What market
Comments

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Notice: Your privacy is important to us. In accordance with our Privacy Policy, the information collected on this form is for internal use by Je T'aime Fragrances only and will not be sold or distributed to anyone.