Membership Application

(New applicants subject to board approval)

Please complete the application below and remit payment to:

Jewelers of Louisiana
c/o C. Bleakley, Exe. Dir.
136 Thoroughbred Ave.
LaPlace, LA 70068

For more information, contact Caroline Bleakley at 504-559-2331 or 985-653-9020, fax 985-653-8666.

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STORE/ASSOCIATE INFORMATION

Business Name:

Contact Person/Title:

Phone:

Fax:

Mailing Address:

Email:

Website:

No. of Employees:

No. of Bench Jewelers:

Tax ID No:

Please provide information for store location #2 (if applicable).

#2 Store Name:

Contact Person/Title:

Phone:

Fax:

Mailing Address:

Email:

Website:

No. of Employees:

No. of Bench Jewelers:

Tax ID No:

Please provide information for store location #3 (if applicable).

#3 Store Name:

Contact Person/Title:

Phone:

Fax:

Mailing Address:

Email:

Website:

No. of Employees:

No. of Bench Jewelers:

Tax ID No:

Please upload a PDF document with additional store location (if applicable).

Upload a PDF document with additional Store Location Info: ×

Store Photos (required)

Store Photos: ×

Prospective members must submit photos of inside and outside of store.

Dues Structure

Number of Membership Stickers needed:

Number of Office Depot Discount Cards needed:

Payment Amount Due Membership Dues are calculated as follows: 1 Store/1 Associate - $120.00/year, plus $20.00 for each additional store.

Remit payment to: J of LA, C. Bleakley, Exe. Dir., 136 Thoroughbred Ave. LaPlace, LA 70068

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