J and R Wholesale Balloon Distributors, LLC

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First name
Last name
Business owner's name (if different)
Title (Mr., Miss, Ms., Dr., etc)
Company
Street
Street line 2
City
State
Postal code
Day time phone
Fax
Email
Web site
Credentials (such as CBA)
Job description (owner, manager, etc)
Type of balloon business
Business location
Seller's permit # (state sales tax #)
Business license #
Membership in professional organizations
How did you hear about J&R?
What items are you interested in?
May we send announcements to you via e-mail?^*
Additional notes
Password (Make this something you'll remember.)
Verify Password (Type the same password again.)
Please answer the following question to verify this is being submitted by a human.
What planet do we live on?

^* J & R Wholesale Balloon Distributors will not share your information with any other businesses or allow other businesses to send unsolicited commercial email to you through our electronic mailing lists. State and federal laws may require that we have your permission before we send commercial email to you. If you tell us that we may send announcements to you, we will send a confirmation notice to the email address you list on this form. You will need to respond to that notice in order for us to complete your request. You may then be removed from the list, simply by asking, any time you wish.