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Request to Become a Dealer

Please complete the form below. Asterisk (*) denotes required fields.

Customer


Bank


Trade References (Two Upholstered Furniture References)

Reference 1
Reference 2

Reference 3

Buyer


Billing


Customer Service


Comments


The submission of this form declares that the submitting party hereby agrees and warrants that all statements made on this credit application, and any accompanying financial information is full, true, and correct. Further, I agree to pay in accordance with my approved credit terms if the account is assigned for collection with an attorney or collection agency. I hereby agree to pay any and all attorney fees, collection and court costs.