IDAHO OPAL MINES, INC.

As a wholesale customer, we must have your resale number on file.  Please print this page and fill in the information below to qualify for wholesale purchases.  Then fax a copy to us at:    Nov-Apr (949) 496-6589  May-Oct (208)374-5356. or you can email this information to us at mailto:opalmine@earthlink.net    Please print legibly

COMPANY NAME

PHONE:                           FAX;                        EMAIL:

PERSON TO CONTACT:

MAILING ADDRESS;

SHIPPING ADDRESS;

TYPE OF BUSINESS:

RESALE OR BUS. #:

STATE 

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