Dealer/General Inquiries

First Name*

Last Name*

Company

Title

Address

City

State/Province

Country

Zip/Postal Code

Telephone*

Fax

E-mail*

Website

Reason for request
Immediate Purchase
Future Purchase
Reference
Type of Business (Check all that apply)
Manufacturer
Interior Design
Workroom
Converter/Importer
Architectural
Distributor
Personal Use
Installation/Contractor
Fabric Jobber
Contract Dealer
Fabricator
Other

please specify

Application (Check all that apply)
Residential
Commercial
Industrial
Type of Business (Check all that apply)
Referral
Direct Mail promotion
Magazine
Other
Trade Show

please specify

Yes, I would like to join the Concord Shading mailing list

Questions/comments/requests


  
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