Welcome to the JDN Online membership application page. Please provide the information requested below. Do not leave any fields blank.  The information that you submit will be used to create our online searchable database. This database will allow other members to find you in a more "user-friendly" fashion. The information provided here will be made available to other dealers around the world, thereby opening new doors of commerce to you and your business. Members of JDN will be able to query the databases in a number of ways.

Business Type
Specialty
Name
Location
Member ID Number
Keywords

By completing this registration form, you are agreeing to the Conditions of Service for the JDN.  Please be certain that you have read the terms of your membership.

MEMBER INFORMATION

First Name:
Middle Initial: 
Last Name:
Company Name:
This is how you will be listed in the Dealer Directory.
Business License:
Email Address:
Address Line 1:
Address Line 2:   
City or Town:
State or Province:
Zip or Postal Code:
Country:
Telephone Number:
Fax Number:
Referred By:
Specialty:

TRADE REFERENCES

Please provide the names and addresses of three (3) verifiable trade/business references.
Name  Address 
Phone    
Name  Address 
Phone    
Name  Address 
Phone    

Payment Method
Select your payment method - Annual membership fee: $439.95 - Get one month free over monthly billing!!
- Monthly membership fee:   $39.95
For a limited time only - Bench Conference Special! - $295.95 for the year!
Credit Card Nbr
Expire Date
Special Note:

User Identification and Passwords

Please input your password and User ID. Your Password is limited to 20 characters. Your User ID is limited to 8 characters and must be created from the character set of digits and LOWERCASE LETTERS. It cannot contain spaces.

User ID:
User ID is limited to 8 characters.
Password:
Password is limited to 20 characters.
Re-type Password to confirm it:

Please enter verification code

Please note: Although it is most unlikely that you will experience any problems responding to this form, certain non-standard browsers will not respond properly. If you experience any difficulties, (or if you are not using a forms-capable browser) you may email your response to this form to: admin@btwtn.com.

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Jewelry Dealers Network, Inc