Wholesale Price List Request Form  (For Retailers)
 ~ Please Print & Return by Fax or Mail ~

Thank you for your interest in Khan Imports. To request a Wholesale Price List,
please print this form, complete and return by fax (805) 967-7128, or mail to:
Khan Imports • 5730 Encina Rd., Suite 1, • Goleta, CA  93117-6250

A copy of your Seller's Permit, Resale Certificate, or Tax I.D. is required,
and must be included with this form for your request to be processed.

Store Name: _____________________________________
Billing Address: _____________________________________
Shipping Address: _____________________________________
Store Telephone: _________________ Home: ______________
Fax Number: _____________________________________
Website Address: _____________________________________
Name / Title: _____________________________________
Email: (Required) _____________________________________

1.  Please select the type of business. (Check all that apply.)
____ Department Store ____ Distributor ____ E-commerce Site
____ Executive Gifts ____ Florist ____ Furnishings/Decor
____ Furniture ____ General Gift ____ Interior Design
____ Manufacturer ____ Museum Shop ____ Nature Store
____ New Age ____ New Business ____ Showroom
____ Souvenir ____ Wholesaler Other _____________

2.  How long has this store been open?
____ Store is not open yet.  (Please also indicate when store will open.)
____ 0 - 3 Months ____ 3 - 6 Months ____ 6 - 12 Months
____ 1 - 2 Years ____ 2 - 5 Years ____ Over 5 years

3.  Does this business have a website?
____ Yes, site address listed above. ____ No, we don't have a website.
____ Yes, site is under construction. ____ No, we're thinking about it.

4.  Does this business have a "physical" retail storefront location?
____ Yes, I listed the location above.
____ Yes, we have a location but have not opened yet.
____ Not at this time, we're thinking about it.
____ No, we retail through our website.
Other Method of Retailing:  (Please specify.)

5.  Does this business directly import any of it's own products?
____ No, we do not import.____ No, we're thinking about it.
Yes, we are currently or have imported from the following countries:
 _______________   _______________   ______________

6.  Please describe the "physical" location of this store.
(Example:  Shopping Mall or Center, Main St., Downtown, Tourist Area,
Show Booth, Kiosk, Fairs or Festivals, Home Based, etc.)

7.  I am interested in the following product types:
____ All Product Types ____ Bookends & Pencil Holders
____ Vases & Planters ____ Desk & Shelf Clocks
____ Bowls, Trays, Wine Glasses____ Boxes, Jars & Canisters
____ Mortar & Pestle Sets ____ Decorative Spheres & Obelisks
____ Drink Coaster Sets____ Animal Figurines & Sculptures

8.  I would like to request the following:  (Check all that apply.)
Please reference our online catalog for initial orders.
____ Please e-mail me a link to your "printable" Wholesale Price List.
____ Please notify me by e-mail of special wholesale offers.
____ Please rush my request, I am interested in placing an order.

9.  Please sign this form prior to submission.  Thank you.
I declare that all information provided on this form is correct and true.
I agree that any pieces purchased from Khan Imports will not be marketed, presented or sold on the Internet (websites, auction sites, etc.) in any way.

Signature  __________________________   Date:  ____________
All information provided is kept strictly confidential.
Please include a copy of your Seller's Permit, Resale Certificate, or Tax I.D.

Give us a call if we can assist you!

EST. 1989

Toll Free:   800-260-1064  •  Tel. 805-967-8050  •  Fax:  805-967-7128
Monday - Friday, 8:00AM - 4:00PM (Pacific Time)
E-mail:  khanimports@yahoo.com
Mailing Address:
5730 Encina Rd., Suite 1
Goleta, CA  93117-6250


Give us a call if we can assist you!

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