Wholesale Account Application

If you do not have an account, please fill out the form below. Upon verification of information we will let you know that your account has been approved.

Company Name:

(required)

Contact Name:

(required)

Business Phone:

(required)

Cell Phone:

Fax:

Your Email:

(required)

Company Website:

Billing Address:

(required)

Shipping Address:

(No P.O. Boxes)

City:

(required)

State/Province:

(required)

Zip/Postal Code:

(required)

Country:

(required)

Retail License #:

(required)

Comments/Questions:

By submitting my information, I understand that I am acquiring a wholesale account with Banayat Fine Art / MiliGirl Collection and that I am subject to the Terms and Use of such account.

Wholesale Account Application

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