First Name*

Last Name*

Company*

Email*

Telephone*

Fax*

Billing Address*

Shipping Address
(if different from
the Billing Address)

Tax ID*
(*Mandatory if in NY State)

(enter n/a above if not sure)

Website URL

Industry*
(please check one)

ADDITIONAL INFORMATION:

How did you hear about
Har-Man Importing?
(please check any that apply)

If you currently purchase
(or have purchased) from
another wholesale supplier,
please tell us why you
are seeking another source.
(Please choose as many
as apply and include
any additional information):

You may submit the credit card authorization form and the net-30 application separately via fax (631) 756-9845 or as an email attachment to account@harmanbeads.com

Terms & Conditions*:
view terms & conditions

One of our knowledgeable sales associates will contact you within 24 hours.