New Customer

Please complete this form to become a dealer or request more information

First Name

Last Name

Position

Company

Street Address

City

Province / State

Postal Code / ZIP

Phone Number

Fax Number

Email Address

Business or Residential address?

Ship to address above? Yes No

Address

City

Province / State

Postal Code / ZIP

# of Years Established

# of Locations

# of Employees

Corporation #

Retail Framer/Art Gallery Wholesaler Distributor/Manufacturer Designer/Decorator/Consultant Photographer Artist

Length Chop Frames Length by Box Photo Frames

Questions / Comments