Welcome to Basha! We are thrilled that you want to partner with us. First, we need to get all your contact information and place your information into our system.

Our sales representative will be calling you soon to learn all about your business, and assist in placing an order. We want to work with you in creating retail strategies for success, and make the most out of this new and exciting partnership!

 

Retailer Form

Company:

E-Mail Address

Name

Last Name

Position

Store Address

Address

City

State/Province

Country

Zip

Work Phone

Extension

Fax

Additional Information

Secondary Phone

List any additional locations

How long have you been in business?

How did you hear about Basha energy jewelry?

What is your business type?

Your website address

List some of the brands your store carries