Company Name:                                                    Date:

Contact Name:          Email Address:   

Resale Number:           Resale State: 

Sales Representative (N/A if none):

Sales Representative Number (N/A if none):

Address:       City:    State:   Zip:

Phone:       Fax:  

URL (website):  

Contact Position: Buyer Merchandiser Owner Other If other, please specify:

Type of Business (you may select more than one) :

Furniture Manufacturer Upholstery Company Outlet Store Retail Store - Gifts   Interior Designer

ECommerce  Wholesaler Manufacturer Other

          If other, please specify (N/A if none):

Have you purchased from us before: Yes No

How did you learn about us:

How many employees does your company have:  

How many stores do you have:

How many years is your company in business: 

Where is most of your business located (State, Country): 

What product price points does your business usually buy (you may select more than one):

Low Medium High

What type of fabrics do you buy? (you may select more than one)

Furniture Window Bedding Kitchen

What quantity of fabrics do you buy? (you may select more than one)

Full Roll Half Roll Cut Yardage

What trade shows do you attend:

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** Upon approval, your account information and login number will be forwarded to you.  Villa Nova De'cor accepts the following forms of payment for online account orders: Visa, MasterCard, American Express, Discover Card, PayPal, and COD.

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