Designer Program Application

Join our Design Direct Program!

Please provide all details to gain access to Kenroy Home's exclusive designer program with exclusive pricing, concierge service, and more!
Name*

First NameLast Name
Contact Number*
Format: (000) 000-0000.
Work E-mail*
example@example.com
Company Name*
Interior DesignerCommercial Interior DesignerLighting ShowroomFurniture ShowroomOther
Incorporation Date

MonthDayYear
Date
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Buyer Email*
example@example.com
Shipping Email*
example@example.com
Accounts Payable Email*
example@example.com
State Sales Tax Number*
State Sales Tax Certificate Upload*

Please upload a copy of your state sales tax certificate
Cancelof
Company Ownership

List ALL Owners, Partners, and Officers.
Full Name*

First NameLast Name
Title/Relationship*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
SSN*
Full Name

First NameLast Name
Title/Relationship
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
SSN
Current CustomerNew CustomerPrevious/Returning CustomerHigh Point/Dallas MarketOther
As a new customer, you agree to:
1) Pay all accounts on or before the due date.
2) Pay all collection costs, if applicable.
3) Any legal action related to collections will be processed in Duval County, Florida.
4) Consent to the use of consumer reports on the company and its officers.

By signing the below, I confirm I have read the above and agree to all terms. I also acknowledge that I have
completed the above truthfully and to the best of my knowledge.
Signature*

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Join our Design Direct Program!