NEW CUSTOMER APPLICATION
BUSINESS (DBA) INFORMATION:
Business Name
*
Contact Name
*
Contact Email
*
example@example.com
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Phone
*
Your Website
Type a question
*
Retail Store
To The Trade Showroom
Designer
Contract
Other
Sales Representative if Known
ACCOUNTING INFORMATION:
Accounting Contact
Accounting Phone
Accounting Email
example@example.com
LIST 3 OTHER FURNITURE SUPPLIERS:
Furniture Suppliers
1
2
3
CURRENT WHOLESALE SHOWROOMS
Are you currently working through any wholesale showrooms?
*
Yes
No
If Yes, please specify:
PREFERRED PROFESSIONAL RECEIVER (SHIP-TO) INFORMATION:
** Receiver Must Have Loading Dock **
Company Name
*
Contact Phone
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
STATE TAX RESALE CERTIFICATE
Please attach your current state Tax Resale Certificate. Your application will not be accepted without a valid resale certificate.
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ADDITIONAL INFORMATION
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