Circa Imports ~ Register

direct wholesale container shipments | personalized customer service | excellent price points

Circa Imports offers substantial incentives to qualified wholesale customers. Access to this site is restricted to those customers.

Wholesale or design customers please fill out the registration form below. After your registration has been submitted, we will contact you by e-mail or phone within two business days to inform you that your user name (view our privacy policy) and password have been activated. We look forward to working with you!

* = required fields
First Name*:		Last Name*:
Company*:		Email*:
Address*:		Address 2:
City*:		State:
Postal Code*:		Country*:
Phone*:		Mobile:
Fax:		Tax ID*:
Username*:		Password*:

Primary Business (check all that apply):
Design Related Services
Retail Showroom
Wholesale

Which terms would you use to describe your inventory (check all that apply):

Antiques	Reproductions	New	Furniture	Accessories
Ceramics	Stone Items	Garden Items	Modern	Rustic
Primitives	Painted	Unpainted	Ethnic	American
European	Asian	Architectural Elements

Additional Notes:

Submission of this form hereby certifies that all tangible personal property purchased by the above person, company or authorized agent, from Circa Imports, Inc., is for the purpose of resale. Submission of this form thereby assumes all responsibility and liability for collect and payment of any and all applicable taxes with respect to receipts from the resale of such property to other users and/or consumers.

In addition to submitting this form electronically by pressing the button below, this form can also be printed off and sent to Circa Imports by fax or mail.