Crystal Chandelier Inc.
  World Trade Center,
P.O. Box 420346,
Dallas, Texas 75342-0346 USA
Fax: 1-604-408-8627

  
Your Buyer Registration Form
Fax to 1-604-408-8627
We are registering this buyer under your name to be sure that you will receive the commission.
Registration Date:
_________________________________________________________
Buyer's First Name:
_________________________________________________________
Buyer's Last Name:
_________________________________________________________
Buyer's Address:
_________________________________________________________
  _________________________________________________________
  _________________________________________________________
  _________________________________________________________
Item number your buyer might purchase:
 ____________________________
Your First Name:
_________________________________________________________
Your Last Name :
_________________________________________________________
Country:
_________________________________________________________
Your JRM ISR No.:
_________________________________________________________
How would you like to be paid?
 
Bank Draft Post Office Ttransfer Bank Wire Transfer (on large amounts)
Your mailing address:
 _________________________________________________________
( if it differs from
your JRM ISR
registration form.)
 _________________________________________________________
_________________________________________________________
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