Thank you for your interest in becoming a Nomination retailer.

For over 20 years Nomination has been creating the original component bracelet guaranteeing the highest quality of its products. The component bracelet consists of stainless steel and 18K gold. Hundreds of different components are available; these are symbols either in gold or enamel or precious/semi precious stones that are great sellers at retail.

Our commitment is to provide high quality products and service in a cost-effective manner, enabling Nomination retailers to excel in serving their customers.

If you have a retail store and are interested in carrying Nomination products, please complete and submit the form below. After you submit this aplication, a Nomination representative will contact you by phone or email. Required fields are marked with a *, but the more complete your application is, the faster it will be processed.

If you experience any technical problems with this form, please call customer service at: 866.266.7672

Region*	Select USA, Canada or Caribbean Europe
Contact information
Store Name*
Address*
Address 2
City*
State*	Select Alberta Alaska Alabama Arkansas Arizona British Columbia California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Manitoba Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Ontario Oregon Pennsylvania Puerto Rico Quebec Rhode Island South Carolina Saskatchewan Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming
ZIP Code*
Country*	USA Netherlands Antilles Argentina Antigua and Barbuda ARUBA Bahamas Bermuda Canada Costa Rica Denmark France Ireland Italy Jamaica Japan Cayman Islands St. Lucia Mexico Norway Puerto Rico ROMANIA Sweden Trinidad and Tobago United Kingdom US Virgin Islands
Phone No.*
Mobile Phone No.
Fax No.
E-mail
Website address
First Name*
Middle Name
Last Name*
Job Title
General
Date Established
Listed with JBT
All prospective accounts must submit one photograph of the exterior of the store, and one of the interior*	I will send pictures by email to: sales@nomination.us
	I will send pictures by postal mail to:         Nomination - Attn: Sales         233 Spring Street, 4th Floor         New York, NY 10013
Comments
Store Type
*	Select Fine Jewelry Jewelry Other
Other
Location
	Select Main street Mall Other Strip mall
Store Size (sq. footage)
Major Lines
1	Select Baume Breitling BULOVA Cartier Charriol Citizen Concord Corum Cyma David Yurman ESQ Gucci Hearts on Fire Hildalgo John Hardy Kwiat Leslie Lladro Mikimoto Mont Blanc Movado Omega Raymond Weil Rembrandt Rolex Scott Kay Seiko Svarowski Swiss Army Tacori Tag Heuer Technomarine Waterford
2	Select Baume Breitling BULOVA Cartier Charriol Citizen Concord Corum Cyma David Yurman ESQ Gucci Hearts on Fire Hildalgo John Hardy Kwiat Leslie Lladro Mikimoto Mont Blanc Movado Omega Raymond Weil Rembrandt Rolex Scott Kay Seiko Svarowski Swiss Army Tacori Tag Heuer Technomarine Waterford
3	Select Baume Breitling BULOVA Cartier Charriol Citizen Concord Corum Cyma David Yurman ESQ Gucci Hearts on Fire Hildalgo John Hardy Kwiat Leslie Lladro Mikimoto Mont Blanc Movado Omega Raymond Weil Rembrandt Rolex Scott Kay Seiko Svarowski Swiss Army Tacori Tag Heuer Technomarine Waterford
4	Select Baume Breitling BULOVA Cartier Charriol Citizen Concord Corum Cyma David Yurman ESQ Gucci Hearts on Fire Hildalgo John Hardy Kwiat Leslie Lladro Mikimoto Mont Blanc Movado Omega Raymond Weil Rembrandt Rolex Scott Kay Seiko Svarowski Swiss Army Tacori Tag Heuer Technomarine Waterford
5	Select Baume Breitling BULOVA Cartier Charriol Citizen Concord Corum Cyma David Yurman ESQ Gucci Hearts on Fire Hildalgo John Hardy Kwiat Leslie Lladro Mikimoto Mont Blanc Movado Omega Raymond Weil Rembrandt Rolex Scott Kay Seiko Svarowski Swiss Army Tacori Tag Heuer Technomarine Waterford
6	Select Baume Breitling BULOVA Cartier Charriol Citizen Concord Corum Cyma David Yurman ESQ Gucci Hearts on Fire Hildalgo John Hardy Kwiat Leslie Lladro Mikimoto Mont Blanc Movado Omega Raymond Weil Rembrandt Rolex Scott Kay Seiko Svarowski Swiss Army Tacori Tag Heuer Technomarine Waterford
7	Select Baume Breitling BULOVA Cartier Charriol Citizen Concord Corum Cyma David Yurman ESQ Gucci Hearts on Fire Hildalgo John Hardy Kwiat Leslie Lladro Mikimoto Mont Blanc Movado Omega Raymond Weil Rembrandt Rolex Scott Kay Seiko Svarowski Swiss Army Tacori Tag Heuer Technomarine Waterford
8	Select Baume Breitling BULOVA Cartier Charriol Citizen Concord Corum Cyma David Yurman ESQ Gucci Hearts on Fire Hildalgo John Hardy Kwiat Leslie Lladro Mikimoto Mont Blanc Movado Omega Raymond Weil Rembrandt Rolex Scott Kay Seiko Svarowski Swiss Army Tacori Tag Heuer Technomarine Waterford
Other
How did you hear about us?*	Select Advertising Customer Mailing Other Another retailer Salesperson Contact Trade Show Telemarketing Contact
...please specify in more detail, if applicable
If you were referred to us by another Nomination retailer, please provide that retailer's store name