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CLIENT REGISTRATION FORM
Please note that it may take UP TO 2 business days to process your registration.
[*denotes required fields, write NONE in fields that do not apply to you]
Name of Company*:
Contact Name*:
Company Address (include address, city, state, zip)*:
Phone #(s)*: [up to 3]
Fax #:
E-mail*:
Website:
Please check one that best describes your company*: [ok to check more than one]
residential interior designer/architect
contract or hospility interior designer/architect
hospitality purchasing agent
 
other
If you have orderd from us before through one of our previous showrooms, please list the name:
How did you hear about Jennifer Robbins Textiles?*:
State Resale #: [state. #]
Tax ID # (if in CA)*:
FedEx/UPS/DHL shipping account #: [company, #]
   
By checking the below box, you acknowledge that you have read and agree the following terms:
I agree with the terms and conditions
   
Please choose a name and password which will be confirmed via email upon approval:
Name:
Password:
   
© 2009 Jennifer Robbins Textiles. All rights reserved.