Wholesale agreement

HobbyLink Japan; April 2009

Please fill out and sign this form and return it to Lance
Braman at Lance@hlj.com or fax it to +81-283-27-2352.

Business Information
Contact Name:
Jovita Kartika Sari
_____________________________________________
Company Name:
Lemonadecious Collections
_____________________________________________
Email:
jovitakartika@yahoo.com
_____________________________________________
Telephone Number:
+6281703110792
_____________________________________________
Fax Number:
+622145854028
_____________________________________________

Mailing Address:
Street 1:
Kelapa Puan Timur 2 NB 2 no. 12, Kelapa
Gading _____________________________________________
Street 2:

_____________________________________________

City:
Jakarta
_____________________________________________
State/Province:
Jakarta Utara
_____________________________________________
Post Code:
14250
_____________________________________________
Country:
Indonesia
_____________________________________________

Shipping Address: (if different)

Street 1:

_____________________________________________

Street 2:

_____________________________________________

City:

_____________________________________________

State/Province:

_____________________________________________

Post Code:

_____________________________________________

Country:

_____________________________________________

Tax ID (if applicable):

______________________________________

Type of Business: (check all that apply)

Retail Store

Website

Conventions

Years in business:
3 years
__________________________________
Annual sales:

Rp. 5.000.000,00

Website address (if applicable):

__________________________________
Preferred Payment Method (check one):
Credit Card

Wire Transfer

Paypal

Please indicate the names of any additional individuals to be

associated with your account:
Name:
Kevin Liandhika
______________________________________
Name:

______________________________________

Product lines carried (circle all that apply):

Scale Models
Comics/Manga

Figures/Sculpts

Gundam/Sci-Fi

Cards/Collectibles

Apparel/Cosplay
Other

Die-cast vehicles
Dolls

R/C and scale slot

Books/Magazines
Hobby Supplies

Product lines you intend to order from HobbyLink Japan (circle

all that apply):
Scale Models
Comics/Manga

Figures/Sculpts

Gundam/Sci-Fi

Cards/Collectibles

Apparel/Cosplay
Other

Die-cast vehicles
Dolls

R/C and scale slot

Books/Magazines
Hobby Supplies

Order Intentions
How frequently do you plan to order from HLJ? (ex: biweekly/monthly/ semi-annually, etc)
semi-annually
______________________________________
At what level do you expect your average shipment to be?
(check one):
60,000 to 140,000 yen

140,000 to 500,000 yen

500,000 to 1,000,000 yen

Over 1,000,000 yen

Do you plan on ordering items in carton quantities (yes/no)?

yes _______

Credit Card Information:

Type of card (check one):
Visa
Mastercard
American Express
Card Number:

_____________________________________________

Expiration Date(YYYY/MM):
___________________________________________
Cardholder Name:
(as it appears on the card):

_____________________________________________

Note: As per the Terms and Conditions please

include:
1.

A scanned copy of your credit card

2.

A copy of your last credit card statement

3.

A copy of some form of personal identification

I, Jovita Kartika Sari, as a representative of

(printed name)

Lemonadecious Collections
(company name and address)

do hereby certify that I have read and fully understand

the terms and conditions given in the Wholesale Terms
and Conditions document and agree to abide by them. I
further agree that HobbyLink Japan has the authority to
charge my credit card for fees as stipulated in these
Terms and Conditions.

________________________________________________
(signature and date)