Wholesale Order Form

Please use this form to place online wholesale orders. Wholesale Accounts may be established by faxing a copy of the wholesale application to 909-752-0200 or email sales@juka.com or call 1-800-535-7573 for further information.

Established Customers:
Please enter your name, Customer ID, telephone number and email. Note any changes in shipping address, billing information, and shipping methods from your previous orders. Wholesale and volume discount pricing and shipping charges will be calculated upon receipt of order. Please be advised that there is a $50 minimum order to qualify for the wholesale order or the prices will be charged at retail - thank you

*Name:*
*Customer ID:*
*Telephone:*
*Email:*

Ship To Address:
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country

Billing Address:
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country

Please provide the following product order information:

PRODUCT CODE	SIZE	QTY	DESCRIPTION

Select a shipping method and payment option.

We ship via United Parcel Service. Please choose a level of service:

Ground
3-Day
2-Day
Overnight

Please select a payment option:

Charge Card	COD (money order/cashiers check)		COD (preapproved check acceptance)
To protect your charge card please enter only the last 4 digits of the card on file that you would like to use. If you do not have a card on file with us please call 1-800-535-7573 to establish one.
Card #		Exp. Date