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NEW CUSTOMER APPLICATION

US/Canadian Business International Business

TYPE OF BUSINESS*

BUSINESS NAME/DBA*

BUSINESS LICENSE #*

TYPE OF OWNERSHIP*

PHYSICAL ADDRESS*

CITY*

STATE*

ZIP/Postal code*

BUSINESS ADDRESS (IF DIFFERENT FROM ABOVE)

PHONE NUMBER*

FAX NUMBER*

MOBILE NUMBER*

OWNER/MANAGER FIRST NAME*

OWNER/MANAGER LAST NAME*

YEARS IN BUSINESS*

ESTIMATED MONTHLY PURCHASES *

WHAT ARE YOUR ANNUAL SALES OF BLINDS AND SHADES?*

LOCATIONS*

# OF EMPLOYEES*

RESALE NUMBER*

Email*

Create your password, username will be emailed to you when your account is active.*

Please attach a copy of your resale certificate/business license*

Accept Terms*

The undersigned herby authorize ALAMODE DECOR to review any information provided for the purpose of establishing a wholesale account. It is agreed that the undersigned will hold harmless the companies engaging in the exchange of such information and understands that the information provided is used for business worthiness as a routine business practice.