Wholesale Request Form

If you already have an existing wholesale account login here.

If you would like to create a wholesale account and gain access to our online product catalog, please fill out the form below, we will handle your request and get back to you asap.

» All fields must be filled out before sumbitting. Thank You.

Full Name:

Email:

Phone:

Fax Number:

Business Name:

Resale License #:

Website Address:

Address:

City & State:

Zip:

How did you hear about JD Vintage?

Jamie Dietrich Vintage Antiques