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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