Business Name
*
Owner's Name
*
First Name
Last Name
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone Number
*
Please enter a valid phone number.
Primary Email Address
*
example@example.com
Resale Certificate Number
Upload Resale Certificate or IRS W9 Form
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of
Years in Business
Yearly Account (check one)
15% Off Discount
5% Quarterly Commission
How Many Purchasers for Your Company?
Are You Interested in Partnering with Us for Promotional Events?
Yes
No
Are You Involved with Any Other Designer or Trade Programs?
Yes
No
Are you presently working with a designer (salesperson) in the Willow showroom?
If "yes" please provide the designer's name.
How Did You Hear About Us?
SUBMIT
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